MEDICARE: MRS. AMY NICOLE PRYCHITKO 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	038011694	IL

General Provider Information

NPI Number	:	1467771261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY NICOLE PRYCHITKO D.C.

Provider Business Mailing Address
First Line	:	800 S WELLS ST
Second Line	:	SUITE 150
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	312-765-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S WELLS ST
Second Line	:	SUITE 150
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	312-765-0411
Fax Number	:

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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