MEDICARE: MR. JILL SUZANNE WHEELER 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4932806	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1124148283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JILL SUZANNE WHEELER DC

Provider Business Mailing Address
First Line	:	PO BOX 5988
Second Line	:	DEPT. 20-5030
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5988
Country	:	US
Telephone Number	:	630-468-1824
Fax Number	:	630-468-1834

Provider Business Practice Location Address
First Line	:	281 W TOWNLINE RD
Second Line	:	SUITE 200
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4334
Country	:	US
Telephone Number	:	224-207-4060
Fax Number	:	630-468-1834

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	02/28/2008

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