MEDICARE: GRISIUS CHIROPRACTIC L.L.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	261QP2000X	Physical Therapy Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1568114106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRISIUS CHIROPRACTIC L.L.C.

Provider Business Mailing Address
First Line	:	1101 N CROSBY ST APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-2537
Country	:	US
Telephone Number	:	847-871-3583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 W BELMONT AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3018
Country	:	US
Telephone Number	:	847-871-3583
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR, OWNER
Name	:	DR. KYLE GRISIUS
Credential	:	DC
Telephone Number	:	847-871-3583

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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