MEDICARE: ANDREW VANTREESE 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	CHIRO06423	GA
2	111N00000X	Chiropractor	038012471	IL

General Provider Information

NPI Number	:	1790979508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW VANTREESE D.C.

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	STE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-320-6400
Fax Number	:	630-701-1007

Provider Business Practice Location Address
First Line	:	3132 N SHEFFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-9024
Country	:	US
Telephone Number	:	773-572-0090
Fax Number	:	773-572-0093

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	07/21/2015

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