MEDICARE: DR. PAMELA J ROUT 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	038-004884	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01482003	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417953613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA J ROUT DC

Provider Business Mailing Address
First Line	:	701 E HANOVER ST
Second Line	:
City	:	NEW BADEN
State	:	IL
Zip	:	62265-1908
Country	:	US
Telephone Number	:	618-588-4976
Fax Number	:	618-588-4926

Provider Business Practice Location Address
First Line	:	701 E HANOVER ST
Second Line	:
City	:	NEW BADEN
State	:	IL
Zip	:	62265-1908
Country	:	US
Telephone Number	:	618-588-4976
Fax Number	:	618-588-4926

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/25/2008

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Directions to “ DR. PAMELA J ROUT DC” Practice Location

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