MEDICARE: DR. ANDREW TUNSTALL 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1032058	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316942592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW TUNSTALL DC

Provider Business Mailing Address
First Line	:	3113 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	217-398-5999
Fax Number	:	217-398-4031

Provider Business Practice Location Address
First Line	:	3113 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	217-398-5999
Fax Number	:	217-398-4031

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. ANDREW TUNSTALL DC” Practice Location

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