MEDICARE: AFFERENT INFLUENCE, LLC

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	038.012971	IL

General Provider Information

NPI Number	:	1427401447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFERENT INFLUENCE, LLC

Provider Business Mailing Address
First Line	:	524 W 5TH AVE
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 W 5TH AVE
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2901
Country	:	US
Telephone Number	:	630-362-6055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM BOLSTER
Credential	:	D.C.
Telephone Number	:	630-362-6055

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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