MEDICARE: SARAH KEUSS, P.C.

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	038010420	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1635345	OTHER	IL	BCBSPROVIDER

General Provider Information

NPI Number	:	1366560666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH KEUSS, P.C.

Provider Business Mailing Address
First Line	:	6818 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4645
Country	:	US
Telephone Number	:	773-282-4529
Fax Number	:

Provider Business Practice Location Address
First Line	:	6818 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4645
Country	:	US
Telephone Number	:	773-282-4529
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SARAH ALEENE KEUSS
Credential	:	D.C.
Telephone Number	:	773-282-4529

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/07/2009

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