MEDICARE: DR. SCOTT E SCHICHTL 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	111NN0400X	Neurology Chiropractor	038007445	IL
2	111NN0400X	Neurology Chiropractor	4861-12	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350054547	OTHER	IL	MEDICARE RAILROAD #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669453056	OTHER	IL	FACILITY NPI

General Provider Information

NPI Number	:	1053302372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT E SCHICHTL DC

Provider Business Mailing Address
First Line	:	1678 NATURES WAY
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-1706
Country	:	US
Telephone Number	:	815-978-8037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1678 NATURES WAY
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-1706
Country	:	US
Telephone Number	:	815-978-8037
Fax Number	:

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	04/09/2012

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Directions to “ DR. SCOTT E SCHICHTL DC” Practice Location

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