MEDICARE: DR. SHAMIKA CORDIS 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	038012064	IL

General Provider Information

NPI Number	:	1457642936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAMIKA CORDIS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 5977
Second Line	:	DEPT 20-3028
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5977
Country	:	US
Telephone Number	:	630-468-1824
Fax Number	:	630-701-1007

Provider Business Practice Location Address
First Line	:	3927 W BELMONT AVE
Second Line	:	STE 101
City	:	CHICAGO
State	:	IL
Zip	:	60618-5170
Country	:	US
Telephone Number	:	773-557-7780
Fax Number	:	773-557-7781

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

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	02/01/2013

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