MEDICARE: DR. DARRIN R FOSZCZ 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	111N00000X	Chiropractor	038-008496	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004932017	OTHER	IL	BCBS PROVIDER #
2	364478173	OTHER	IL	TAX ID #

General Provider Information

NPI Number	:	1013025824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRIN R FOSZCZ D.C.

Provider Business Mailing Address
First Line	:	2207 N US HIGHWAY 12
Second Line	:	SUITE E
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:	815-675-9323

Provider Business Practice Location Address
First Line	:	2207 N US HIGHWAY 12
Second Line	:	SUITE E
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:	815-675-9323

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	02/15/2010

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