MEDICARE: DR. CHRISTOPHER J HALLIDAY

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	038-009504	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35-2311941	OTHER	IL	FEIN
2	7859515	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1063432532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J HALLIDAY

Provider Business Mailing Address
First Line	:	1225 W MORSE AVE
Second Line	:	#401
City	:	CHICAGO
State	:	IL
Zip	:	60626-5798
Country	:	US
Telephone Number	:	773-931-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 N. ASHLAND AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-248-4229
Fax Number	:	773-248-4222

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/01/2008

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