MEDICARE: PHYSICAL MEDICINE ASSOCIATES, SC

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	:	1982872792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL MEDICINE ASSOCIATES, SC

Provider Business Mailing Address
First Line	:	24W500 MAPLE AVE
Second Line	:	SUITE 105
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6055
Country	:	US
Telephone Number	:	630-428-4300
Fax Number	:	630-428-4305

Provider Business Practice Location Address
First Line	:	5803 W CRAIG RD
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2536
Country	:	US
Telephone Number	:	630-428-4300
Fax Number	:	630-428-4305

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TARYN N HALL
Credential	:
Telephone Number	:	630-428-4300

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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