MEDICARE: JENNIFER MARIE SPILOTRO M.S., R.D., L.D.N.

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	133N00000X	Nutritionist	164004632	IL
2	133V00000X	Registered Dietitian	164004632	IL
3	261QR1100X	Research Clinic/Center	164004632	IL
4	283Q00000X	Psychiatric Hospital	164004632	IL
5	310400000X	Assisted Living Facility	164004632	IL
6	313M00000X	Nursing Facility/Intermediate Care Facility	164004632	IL

General Provider Information

NPI Number	:	1043458938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE SPILOTRO M.S., R.D., L.D.N.

Provider Business Mailing Address
First Line	:	2610 N ORCHARD ST
Second Line	:	#B
City	:	CHICAGO
State	:	IL
Zip	:	60614-7156
Country	:	US
Telephone Number	:	847-373-7891
Fax Number	:	773-539-0039

Provider Business Practice Location Address
First Line	:	5061 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	773-539-8181
Fax Number	:	773-539-0039

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/30/2009

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