MEDICARE: DR. DANS CHIROPRACTIC SERVICES

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		IL

General Provider Information

NPI Number	:	1316068687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DANS CHIROPRACTIC SERVICES

Provider Business Mailing Address
First Line	:	314 W ROLLINS RD STE A
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Provider Business Practice Location Address
First Line	:	314 W ROLLINS RD STE A
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DANIEL M VANDERWEIT
Credential	:	D.C
Telephone Number	:	847-546-4220

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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