MEDICARE: MRS. ILZE LIEPINS 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	111NI0900X	Internist Chiropractor	038010399	IL

General Provider Information

NPI Number	:	1336166164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILZE LIEPINS DC

Provider Business Mailing Address
First Line	:	1605 S MICHIGAN AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616
Country	:	US
Telephone Number	:	312-212-1404
Fax Number	:	312-212-1434

Provider Business Practice Location Address
First Line	:	1605 S MICHIGAN AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616
Country	:	US
Telephone Number	:	312-212-1404
Fax Number	:	312-212-1434

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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