MEDICARE: DR. JONATHAN SEEZOX DC

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		IL

General Provider Information

NPI Number	:	1518009885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SEEZOX DC

Provider Business Mailing Address
First Line	:	1500 CARLEMONT DR
Second Line	:	SUITE M
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1833
Country	:	US
Telephone Number	:	815-444-1636
Fax Number	:	312-928-0682

Provider Business Practice Location Address
First Line	:	1500 CARLEMONT DR
Second Line	:	SUITE M
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1833
Country	:	US
Telephone Number	:	815-444-1636
Fax Number	:	312-928-0682

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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