MEDICARE: GENTLE HANDS CHIROPRACTIC, PC

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	038011199	IL

General Provider Information

NPI Number	:	1922261072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE HANDS CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	140 E 1ST ST
Second Line	:
City	:	BRAIDWOOD
State	:	IL
Zip	:	60408-1703
Country	:	US
Telephone Number	:	815-458-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W KENNEDY RD
Second Line	:
City	:	BRAIDWOOD
State	:	IL
Zip	:	60408-1931
Country	:	US
Telephone Number	:	815-458-2225
Fax Number	:	866-272-7518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN HUGH BRAITHWAITE
Credential	:	D.C.
Telephone Number	:	815-458-2225

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	07/09/2008

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