MEDICARE: KRISTEN A ACCARDO 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	038012304	IL

General Provider Information

NPI Number	:	1215087598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN A ACCARDO D.C.

Provider Business Mailing Address
First Line	:	1231 FARMINGTON LAKES DRIVE
Second Line	:	SUITE 101
City	:	OSWEGO
State	:	IL
Zip	:	60543-9040
Country	:	US
Telephone Number	:	331-212-6962
Fax Number	:	630-429-9276

Provider Business Practice Location Address
First Line	:	1231 FARMINGTON LAKES DRIVE
Second Line	:	SUITE 101
City	:	OSWEGO
State	:	IL
Zip	:	60543-9040
Country	:	US
Telephone Number	:	331-212-6962
Fax Number	:	630-429-9276

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	11/25/2014

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