MEDICARE: MCGILLEM CHIROPRACTIC & REHABILITATION

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	08002450A	IN

General Provider Information

NPI Number	:	1295061596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGILLEM CHIROPRACTIC & REHABILITATION

Provider Business Mailing Address
First Line	:	855 N HIGH SCHOOL RD STE 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5702
Country	:	US
Telephone Number	:	317-270-9500
Fax Number	:	317-270-9502

Provider Business Practice Location Address
First Line	:	855 N HIGH SCHOOL RD STE 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5702
Country	:	US
Telephone Number	:	317-270-9500
Fax Number	:	317-270-9502

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. DEVON TYLER MCGILLEM
Credential	:	D.C.
Telephone Number	:	317-270-9500

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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