MEDICARE: DR. ELONA MARY WALSH 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01627839	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1518089671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELONA MARY WALSH D.C.

Provider Business Mailing Address
First Line	:	4850 N CENTRAL PARK AVE
Second Line	:	# 1
City	:	CHICAGO
State	:	IL
Zip	:	60625-5604
Country	:	US
Telephone Number	:	773-539-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 N LAKE TER
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1335
Country	:	US
Telephone Number	:	708-997-6221
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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