MEDICARE: DR. PATRICK RYAN MALARTSIK 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	038012023	IL

General Provider Information

NPI Number	:	1063794535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK RYAN MALARTSIK DC

Provider Business Mailing Address
First Line	:	2828 N CLARK ST
Second Line	:	7TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60657-5775
Country	:	US
Telephone Number	:	773-549-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 N CLARK ST
Second Line	:	7TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60657-5775
Country	:	US
Telephone Number	:	773-549-5040
Fax Number	:

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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