MEDICARE: DR. GEORGE K. MICHALOPOULOS 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02222753	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1063416014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE K. MICHALOPOULOS D.C.

Provider Business Mailing Address
First Line	:	199 S ADDISON RD
Second Line	:	STE 105-106
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1534
Country	:	US
Telephone Number	:	630-766-1552
Fax Number	:	630-766-4220

Provider Business Practice Location Address
First Line	:	199 S ADDISON RD
Second Line	:	STE 105-106
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1534
Country	:	US
Telephone Number	:	630-766-1552
Fax Number	:	630-766-4220

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/07/2008

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Directions to “ DR. GEORGE K. MICHALOPOULOS D.C.” Practice Location

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