MEDICARE: ACCELERATED SPORTS PERFORMANCE CENTERS, 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	111NS0005X	Sports Physician Chiropractor	038-009825	IL

General Provider Information

NPI Number	:	1861638991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCELERATED SPORTS PERFORMANCE CENTERS, INC.

Provider Business Mailing Address
First Line	:	195 N HARBOR DR
Second Line	:	UNIT 2908
City	:	CHICAGO
State	:	IL
Zip	:	60601-7514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 N HARBOR DR
Second Line	:	UNIT 2908
City	:	CHICAGO
State	:	IL
Zip	:	60601-7514
Country	:	US
Telephone Number	:	312-402-0081
Fax Number	:

Authorized Official
Title or Position	:	CEO/CHIROPRACTOR
Name	:	DIVYA J SHARMA
Credential	:	D.C.
Telephone Number	:	312-402-0081

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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