MEDICARE: REITER CHIROPRACTIC & REHAB CTR

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	111NR0400X	Rehabilitation Chiropractor		IL

General Provider Information

NPI Number	:	1154508745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REITER CHIROPRACTIC & REHAB CTR

Provider Business Mailing Address
First Line	:	6350 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4706
Country	:	US
Telephone Number	:	773-767-2225
Fax Number	:	773-767-9604

Provider Business Practice Location Address
First Line	:	6350 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4706
Country	:	US
Telephone Number	:	773-767-2225
Fax Number	:	773-767-9604

Authorized Official
Title or Position	:	BILLER
Name	:	MRS. GABRIELA MENDOZA
Credential	:
Telephone Number	:	773-767-2225

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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