MEDICARE: GUTRICH CHIROPRACTIC, 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	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01634073	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972518421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUTRICH CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1425 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1111
Country	:	US
Telephone Number	:	773-472-0700
Fax Number	:	773-472-0300

Provider Business Practice Location Address
First Line	:	1425 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1111
Country	:	US
Telephone Number	:	773-472-0700
Fax Number	:	773-472-0300

Authorized Official
Title or Position	:	CEO
Name	:	DR. JANET MARIE GUTRICH
Credential	:	D.C.
Telephone Number	:	773-472-0700

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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