MEDICARE: DR. HEIDI COLEHOUR DC

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	038009629	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10132055	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1568506293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI COLEHOUR DC

Provider Business Mailing Address
First Line	:	6270 E RIVERSIDE BLVD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4418
Country	:	US
Telephone Number	:	815-636-2225
Fax Number	:	815-636-2863

Provider Business Practice Location Address
First Line	:	6270 E RIVERSIDE BLVD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4418
Country	:	US
Telephone Number	:	815-636-2225
Fax Number	:	815-636-2863

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/10/2011

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Directions to “ DR. HEIDI COLEHOUR DC” Practice Location

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