MEDICARE: SMITH CHIROPRACTIC HEALTH CARE, SC

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	038-004027	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1635180	OTHER	IL	BLUE CROSS OF IL

General Provider Information

NPI Number	:	1114125788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH CHIROPRACTIC HEALTH CARE, SC

Provider Business Mailing Address
First Line	:	7716 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4123
Country	:	US
Telephone Number	:	708-456-8844
Fax Number	:	708-456-5550

Provider Business Practice Location Address
First Line	:	7716 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4123
Country	:	US
Telephone Number	:	708-456-8844
Fax Number	:	708-456-5550

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. CARLY SMITH
Credential	:
Telephone Number	:	708-456-8844

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	08/15/2024

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