MEDICARE: NATHAN WILLIAM PORRITT 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	038010826	IL

General Provider Information

NPI Number	:	1528119757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN WILLIAM PORRITT D.C.

Provider Business Mailing Address
First Line	:	108 W RIPLEY ST
Second Line	:
City	:	TREMONT
State	:	IL
Zip	:	61568-8568
Country	:	US
Telephone Number	:	309-925-2109
Fax Number	:	309-383-2773

Provider Business Practice Location Address
First Line	:	387 OLD GERMANTOWN RD
Second Line	:
City	:	METAMORA
State	:	IL
Zip	:	61548-8679
Country	:	US
Telephone Number	:	309-383-2772
Fax Number	:	309-383-2773

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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