MEDICARE: DR. JON A PAUL 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	038-003772	IL

General Provider Information

NPI Number	:	1407851264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON A PAUL D.C.

Provider Business Mailing Address
First Line	:	2477 EASTROCK DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-8077
Country	:	US
Telephone Number	:	815-397-0935
Fax Number	:	815-397-3017

Provider Business Practice Location Address
First Line	:	2477 EASTROCK DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-8077
Country	:	US
Telephone Number	:	815-397-0935
Fax Number	:	815-397-3017

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/18/2008

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