MEDICARE: NOURISHING MEDICINE,LLC

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	111NN1001X	Nutrition Chiropractor	038006687	IL
2	111NI0900X	Internist Chiropractor	038006687	IL

General Provider Information

NPI Number	:	1295943108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHING MEDICINE,LLC

Provider Business Mailing Address
First Line	:	4082 RIVER RDG
Second Line	:
City	:	SANDWICH
State	:	IL
Zip	:	60548-6905
Country	:	US
Telephone Number	:	630-479-9355
Fax Number	:	630-566-1633

Provider Business Practice Location Address
First Line	:	101 EAST SECOND STREET
Second Line	:	UNIT 2
City	:	BIG ROCK
State	:	IL
Zip	:	60511-0173
Country	:	US
Telephone Number	:	630-479-9355
Fax Number	:	630-566-1633

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. DELILAH ANDERSON
Credential	:	DC
Telephone Number	:	630-561-9696

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	03/07/2014

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