MEDICARE: DEMPSTER MEDICAL & CHIROPRACTIC CLINIC 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	038-006602	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1682333	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1043279276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEMPSTER MEDICAL & CHIROPRACTIC CLINIC SC

Provider Business Mailing Address
First Line	:	4711 GOLF RD
Second Line	:	SUITE 413
City	:	SKOKIE
State	:	IL
Zip	:	60076-1224
Country	:	US
Telephone Number	:	847-673-5080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 GOLF RD
Second Line	:	SUITE 413
City	:	SKOKIE
State	:	IL
Zip	:	60076-1224
Country	:	US
Telephone Number	:	847-673-5080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN B DEMERER
Credential	:	DC
Telephone Number	:	847-673-5080

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/30/2009

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