MEDICARE: DR. ALICIA JANE GRUNDY DC

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	038-009485	IL

General Provider Information

NPI Number	:	1043381650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA JANE GRUNDY DC

Provider Business Mailing Address
First Line	:	600 N NORTH CT STE 100
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-8155
Country	:	US
Telephone Number	:	847-358-9999
Fax Number	:	847-358-7651

Provider Business Practice Location Address
First Line	:	357 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-358-9999
Fax Number	:	847-358-7651

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	05/18/2015

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