MEDICARE: GOODFELLOW 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	111N00000X	Chiropractor	038008453	IL

General Provider Information

NPI Number	:	1265736086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODFELLOW CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	6630 W HIGGINS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-2138
Country	:	US
Telephone Number	:	773-237-5757
Fax Number	:	773-442-0194

Provider Business Practice Location Address
First Line	:	6630 W HIGGINS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-2138
Country	:	US
Telephone Number	:	773-237-5757
Fax Number	:	773-442-0194

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN G. GOODFELLOW III
Credential	:	DC
Telephone Number	:	773-237-5757

Provider Enumeration Date	:	01/08/2011
Last Update Date	:	01/23/2013

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