MEDICARE: A.P. CHARLES NEUROMYOLOGY

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	172P00000X	Naprapath	181000377	IL

General Provider Information

NPI Number	:	1538407622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.P. CHARLES NEUROMYOLOGY

Provider Business Mailing Address
First Line	:	3620 N PINE GROVE AVE
Second Line	:	508
City	:	CHICAGO
State	:	IL
Zip	:	60613-4552
Country	:	US
Telephone Number	:	773-312-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N PINE GROVE AVE
Second Line	:	508
City	:	CHICAGO
State	:	IL
Zip	:	60613-4552
Country	:	US
Telephone Number	:	773-312-2659
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABIDEMI CHARLES
Credential	:	D.N.
Telephone Number	:	773-312-2659

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	06/03/2013

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