MEDICARE: ERIC R. GHISELLI 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	038.011228	IL

General Provider Information

NPI Number	:	1467600312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC R. GHISELLI D.C.

Provider Business Mailing Address
First Line	:	2936 N RACINE AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4236
Country	:	US
Telephone Number	:	765-532-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 N RACINE AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4236
Country	:	US
Telephone Number	:	765-532-5981
Fax Number	:

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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