MEDICARE: MS. CATHERINE M. HOLTSCHLAG 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	038-0007811	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000108493	OTHER	IL	BLUE SHIELD

General Provider Information

NPI Number	:	1013054873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE M. HOLTSCHLAG D.C.

Provider Business Mailing Address
First Line	:	207 W WOOD ST
Second Line	:
City	:	CAMP POINT
State	:	IL
Zip	:	62320-1301
Country	:	US
Telephone Number	:
Fax Number	:	217-593-6399

Provider Business Practice Location Address
First Line	:	207 W WOOD ST
Second Line	:
City	:	CAMP POINT
State	:	IL
Zip	:	62320-1301
Country	:	US
Telephone Number	:	217-593-6399
Fax Number	:	217-593-6399

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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