MEDICARE: DR. STEPHEN DANIEL PERAKIS 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	38010732	IL

General Provider Information

NPI Number	:	1457360547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DANIEL PERAKIS D.C.

Provider Business Mailing Address
First Line	:	4615 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-423-9800
Fax Number	:	708-423-9803

Provider Business Practice Location Address
First Line	:	4615 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-423-9800
Fax Number	:	708-423-9803

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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