MEDICARE: PROPER BALANCE HEALTHCARE

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	261Q00000X	Clinic/Center		IL

General Provider Information

NPI Number	:	1548443088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROPER BALANCE HEALTHCARE

Provider Business Mailing Address
First Line	:	800 S WELLS ST STE 150
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	312-339-5571
Fax Number	:	312-280-1570

Provider Business Practice Location Address
First Line	:	800 S WELLS ST STE 150
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	312-339-5571
Fax Number	:	312-280-1570

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTINA CREEVY
Credential	:	D.C.
Telephone Number	:	312-339-5571

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	01/18/2008

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