MEDICARE: CHIROPRACTICWORKSLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06032272	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1215100227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTICWORKSLLC

Provider Business Mailing Address
First Line	:	410 REGENCY CTR
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4659
Country	:	US
Telephone Number	:	618-343-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 REGENCY CTR
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4659
Country	:	US
Telephone Number	:	618-343-3602
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTOPHER MICHAEL MCCLUSKY
Credential	:	DC
Telephone Number	:	618-343-3602

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	07/26/2008

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Directions to “CHIROPRACTICWORKSLLC ” Practice Location

Language	Start Address	Practice Location

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