MEDICARE: DR. GERARD CARR HINLEY 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0221-5600	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861557886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD CARR HINLEY D.C.

Provider Business Mailing Address
First Line	:	954 CRESCENT BLVD
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-4255
Country	:	US
Telephone Number	:	630-469-9233
Fax Number	:	630-690-4680

Provider Business Practice Location Address
First Line	:	1136 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3498
Country	:	US
Telephone Number	:	630-690-4488
Fax Number	:	630-690-4680

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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