MEDICARE: MRS. PRISCILLA Y CALDERONE DC

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	038010861	IL

General Provider Information

NPI Number	:	1730225061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA Y CALDERONE DC

Provider Business Mailing Address
First Line	:	2134 S ARCHER AVE STE B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1514
Country	:	US
Telephone Number	:	312-842-9831
Fax Number	:

Provider Business Practice Location Address
First Line	:	2134 B S ARCHER AVENUE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60616
Country	:	US
Telephone Number	:	312-842-9831
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/24/2011

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