=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104840131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTON J. RITTLING D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 11/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5360 N LINCOLN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-334-1515
-----------------------------------------------------
Fax | 773-334-1696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5360 N LINCOLN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-334-1515
-----------------------------------------------------
Fax | 773-334-1696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-003907
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------