MEDICARE: DR. DANIEL JOSEPH JACOBAZZI P.T.

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	038-008864	IL
2	225100000X	Physical Therapist	070018357	IL

General Provider Information

NPI Number	:	1396758603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JOSEPH JACOBAZZI P.T.

Provider Business Mailing Address
First Line	:	1820 W IRVING PARK RD
Second Line	:	#1 W
City	:	CHICAGO
State	:	IL
Zip	:	60613-2406
Country	:	US
Telephone Number	:	773-852-3335
Fax Number	:	773-751-5292

Provider Business Practice Location Address
First Line	:	1820 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2402
Country	:	US
Telephone Number	:	773-852-3335
Fax Number	:	773-751-5292

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/23/2016

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