MEDICARE: DR. NICHOLAS DEIGNAN D.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	4200	OH
2	111N00000X	Chiropractor	038011878	IL

General Provider Information

NPI Number	:	1366740128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS DEIGNAN D.C.

Provider Business Mailing Address
First Line	:	777 LAKE ZURICH RD
Second Line	:	105
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3106
Country	:	US
Telephone Number	:	847-277-2990
Fax Number	:	847-277-2991

Provider Business Practice Location Address
First Line	:	777 LAKE ZURICH RD
Second Line	:	105
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3106
Country	:	US
Telephone Number	:	847-277-2990
Fax Number	:	847-277-2991

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

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	10/22/2014

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