MEDICARE: MR. DALE ALLEN ZUEHLKE DC

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	038005091	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04982061	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1306854153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE ALLEN ZUEHLKE DC

Provider Business Mailing Address
First Line	:	561 W DIVERSEY PKWY STE 221
Second Line	:	GREATER CHICAGO CHIROPRACTIC
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-871-7766
Fax Number	:	773-871-0780

Provider Business Practice Location Address
First Line	:	561 W DIVERSEY PKWY STE 221
Second Line	:	GREATER CHICAGO CHIROPRACTIC
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-871-7766
Fax Number	:	773-871-0780

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/30/2011

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