MEDICARE: DISCOVER CHIROPRACTIC HEALTH CENTER LTD

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	038008496	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7654372	OTHER	IL	AETNA
2	04932017	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1164647442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVER CHIROPRACTIC HEALTH CENTER LTD

Provider Business Mailing Address
First Line	:	2207 N US HIGHWAY 12
Second Line	:	SUITE E
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:	815-975-9323

Provider Business Practice Location Address
First Line	:	2207 N US HIGHWAY 12
Second Line	:	SUITE E
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:	815-975-9323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARRIN R. FOSZCZ
Credential	:	D.C.
Telephone Number	:	815-675-9355

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	02/16/2010

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