MEDICARE: DR. ROBERT DAVID PYNE D.C.

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	111NI0900X	Internist Chiropractor	038-005416	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001682418	OTHER	IL	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1003816067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DAVID PYNE D.C.

Provider Business Mailing Address
First Line	:	10413 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1931
Country	:	US
Telephone Number	:	708-599-9585
Fax Number	:	708-599-9598

Provider Business Practice Location Address
First Line	:	10413 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1931
Country	:	US
Telephone Number	:	708-599-9585
Fax Number	:	708-599-9598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/20/2008

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