MEDICARE: DR. EDGARDO ROBERTO VARGAS 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	038-010690	IL

General Provider Information

NPI Number	:	1750466991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARDO ROBERTO VARGAS DC

Provider Business Mailing Address
First Line	:	5625 N SPAULDING AVE
Second Line	:	UNIT 1N
City	:	CHICAGO
State	:	IL
Zip	:	60659-3675
Country	:	US
Telephone Number	:	630-706-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4010
Country	:	US
Telephone Number	:	773-777-0709
Fax Number	:	773-777-0734

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/25/2008

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