MEDICARE: DR. LORI E PORTNOY

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

General Provider Information

NPI Number	:	1861676207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI E PORTNOY

Provider Business Mailing Address
First Line	:	954 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4222
Country	:	US
Telephone Number	:	773-248-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4222
Country	:	US
Telephone Number	:	773-248-2323
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	03/27/2008

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Directions to “ DR. LORI E PORTNOY ” Practice Location

Language	Start Address	Practice Location

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