MEDICARE: TAMMY PHAM 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	038.012324	IL

General Provider Information

NPI Number	:	1154669091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY PHAM D.C.

Provider Business Mailing Address
First Line	:	2322 N COMMONWEALTH AVE APT 510
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2322 N COMMONWEALTH AVE APT 510
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3408
Country	:	US
Telephone Number	:	260-413-5044
Fax Number	:

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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