MEDICARE: DR. SALMA MITHA 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	038.011767	IL

General Provider Information

NPI Number	:	1073823894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALMA MITHA D.C

Provider Business Mailing Address
First Line	:	2933 NORTH SHERIDAN ROAD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	794-789-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4236 NORTH CICERO AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641
Country	:	US
Telephone Number	:	704-789-3363
Fax Number	:

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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