MEDICARE: MIDWEST NEURO DX, S.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	111NN0400X	Neurology Chiropractor	038007445	IL

General Provider Information

NPI Number	:	1255763199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST NEURO DX, S.C.

Provider Business Mailing Address
First Line	:	1678 NATURES WAY
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-1706
Country	:	US
Telephone Number	:	847-504-9352
Fax Number	:	847-892-4140

Provider Business Practice Location Address
First Line	:	1678 NATURES WAY
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-1706
Country	:	US
Telephone Number	:	847-504-9352
Fax Number	:	847-892-4140

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT E SCHICHTL
Credential	:	DC
Telephone Number	:	847-504-9352

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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