MEDICARE: DR. MIGUEL A JIMENEZ D.C., S.A.

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	246ZC0007X	Surgical Assistant	238000485	IL
2	111N00000X	Chiropractor	038-009097	IL

General Provider Information

NPI Number	:	1891764098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL A JIMENEZ D.C., S.A.

Provider Business Mailing Address
First Line	:	PO BOX 8373
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-0373
Country	:	US
Telephone Number	:	773-954-4438
Fax Number	:

Provider Business Practice Location Address
First Line	:	2548 S. BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	773-954-4438
Fax Number	:	773-823-1746

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	03/30/2022

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