MEDICARE: DR. LEA MAE HOLCOMB 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	111N00000X	Chiropractor	038011496	IL

General Provider Information

NPI Number	:	1386875490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEA MAE HOLCOMB DC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	STE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-320-6400
Fax Number	:	630-701-1007

Provider Business Practice Location Address
First Line	:	281 W TOWNLINE RD
Second Line	:	STE 200
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4334
Country	:	US
Telephone Number	:	224-207-4060
Fax Number	:	224-207-4065

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	07/23/2015

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