MEDICARE: AMELIA CASE 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	038-006722	IL

General Provider Information

NPI Number	:	1386735322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA CASE D.C.

Provider Business Mailing Address
First Line	:	3400 N LAKE SHORE DR
Second Line	:	#8D
City	:	CHICAGO
State	:	IL
Zip	:	60657-2827
Country	:	US
Telephone Number	:	773-848-6898
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 W CHESTNUT ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-3313
Country	:	US
Telephone Number	:	312-266-9090
Fax Number	:	312-266-9491

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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