MEDICARE: DR. JULI WEBER MICETICH 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	038007825	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350054286	OTHER	IL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1467454587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULI WEBER MICETICH D.C.

Provider Business Mailing Address
First Line	:	24 E NORTH ST
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1087
Country	:	US
Telephone Number	:	815-634-0445
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 E NORTH ST
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1087
Country	:	US
Telephone Number	:	815-634-0445
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/08/2012

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