MEDICARE: DUTKA CHIROPRACTIC & WELLNESS, S.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	038011246	IL

General Provider Information

NPI Number	:	1366683039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUTKA CHIROPRACTIC & WELLNESS, S.C.

Provider Business Mailing Address
First Line	:	1514 S PRINCETON AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3415
Country	:	US
Telephone Number	:	847-670-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 S PRINCETON AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3415
Country	:	US
Telephone Number	:	847-670-1730
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AARON C. DUTKA
Credential	:	D.C.
Telephone Number	:	847-670-1730

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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