MEDICARE: DR. JAMES DANIEL KIRK 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	038-010069	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2221717	OTHER	IL	BCBS ID

General Provider Information

NPI Number	:	1780750356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANIEL KIRK D.C.

Provider Business Mailing Address
First Line	:	6230 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-1908
Country	:	US
Telephone Number	:	630-960-9914
Fax Number	:	630-960-9924

Provider Business Practice Location Address
First Line	:	6230 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-1908
Country	:	US
Telephone Number	:	630-960-9914
Fax Number	:	630-960-9924

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/27/2020

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