MEDICARE: LINCOLN PARK CHIROPRACTIC, PC

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	111NS0005X	Sports Physician Chiropractor	38-007442	IL

General Provider Information

NPI Number	:	1205059912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN PARK CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	2202 N LINCOLN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60614-7170
Country	:	US
Telephone Number	:	773-248-2790
Fax Number	:	773-248-2058

Provider Business Practice Location Address
First Line	:	2202 N LINCOLN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60614-7170
Country	:	US
Telephone Number	:	773-248-2790
Fax Number	:	773-248-2058

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER F. ZID
Credential	:	D.C.
Telephone Number	:	773-248-2790

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/27/2010

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