MEDICARE: THOMAS JOHN AMBROSE DC

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	038.013667	IL

General Provider Information

NPI Number	:	1194300814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOHN AMBROSE DC

Provider Business Mailing Address
First Line	:	1604 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2231
Country	:	US
Telephone Number	:	708-745-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2231
Country	:	US
Telephone Number	:	708-745-1086
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “ THOMAS JOHN AMBROSE DC” Practice Location

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