MEDICARE: JUAREZ CHIROPRACTIC INC.

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	038011846	IL

General Provider Information

NPI Number	:	1790080232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAREZ CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	4614 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4040
Country	:	US
Telephone Number	:	773-823-7005
Fax Number	:	888-416-9095

Provider Business Practice Location Address
First Line	:	4614 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4040
Country	:	US
Telephone Number	:	773-823-7005
Fax Number	:	888-416-9095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RODRIGO JUAREZ JR.
Credential	:	D.C.
Telephone Number	:	773-823-7005

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/20/2011

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