MEDICARE: DR. LESLIE BULYAKI D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	797550	OTHER	IL	GROUP MEDICARE NUMBER

General Provider Information

NPI Number	:	1720133838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE BULYAKI D.C

Provider Business Mailing Address
First Line	:	5315 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2531
Country	:	US
Telephone Number	:	773-275-3200
Fax Number	:	773-275-2877

Provider Business Practice Location Address
First Line	:	5315 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2531
Country	:	US
Telephone Number	:	773-275-3200
Fax Number	:	773-275-2877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. LESLIE BULYAKI D.C” Practice Location

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