MEDICARE: COLER CHIROPRACTIC CENTER 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	111NS0005X	Sports Physician Chiropractor	038006558	IL

General Provider Information

NPI Number	:	1982750527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLER CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	6657 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2419
Country	:	US
Telephone Number	:	773-229-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	6657 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2419
Country	:	US
Telephone Number	:	773-229-8888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH COLER
Credential	:	D.C.
Telephone Number	:	773-229-8888

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	03/01/2012

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