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NPI Code Detail

MEDICARE: DR. DAPHNE ROSCOE D.C.

MEDICARE:  DR. DAPHNE  ROSCOE  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
1111N00000XChiropractor8071TX
2111N00000XChiropractorIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111628176OTHERILCAQH

General Provider Information

NPI Number : 1144419623
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAPHNE ROSCOE D.C.
Provider Business Mailing Address
First Line : 3846 N LOWELL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2854
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4337 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2830
Country : US
Telephone Number : 713-410-3776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2007
Last Update Date : 01/21/2008

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Directions to “ DR. DAPHNE ROSCOE D.C.” Practice Location

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