MEDICARE: DR. DAVID M KORTAN 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

General Provider Information

NPI Number	:	1568445971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M KORTAN D.C.

Provider Business Mailing Address
First Line	:	2982 ANDRUS DR
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-5211
Country	:	US
Telephone Number	:	630-762-9427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1310
Country	:	US
Telephone Number	:	630-894-0550
Fax Number	:	630-894-0697

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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