MEDICARE: ROBERT T WRIGHT 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	038-005911	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01608565	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1245239474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT T WRIGHT D.C.

Provider Business Mailing Address
First Line	:	12770 S HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-671-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	12770 S HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-671-1400
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/18/2024

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