MEDICARE: DR. SEAN BUSHNELL 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	38007892	IL

General Provider Information

NPI Number	:	1184754491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN BUSHNELL D.C.

Provider Business Mailing Address
First Line	:	11245 WILD BERRY LAN
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-3408
Country	:	US
Telephone Number	:	708-478-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3408
Country	:	US
Telephone Number	:	773-772-0007
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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