MEDICARE: DR. ALEXANDER FEDOROV 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	38009253	IL

General Provider Information

NPI Number	:	1740227958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER FEDOROV D.C.

Provider Business Mailing Address
First Line	:	210 SHADOWBEND DR
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-3162
Country	:	US
Telephone Number	:	847-840-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 N WOLF RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1749
Country	:	US
Telephone Number	:	847-297-2225
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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