MEDICARE: LAKESHORE INTEGRATIVE HEALTHCARE, LTD

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	181-000304	IL
2	133N00000X	Nutritionist	181-000304	IL
3	225100000X	Physical Therapist	070010058	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633587	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1568642791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE INTEGRATIVE HEALTHCARE, LTD

Provider Business Mailing Address
First Line	:	2731 N SEMINARY AVE
Second Line	:	STE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1322
Country	:	US
Telephone Number	:	773-972-6566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 N LINCOLN AVE
Second Line	:	STE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-7170
Country	:	US
Telephone Number	:	312-698-9855
Fax Number	:	312-698-9857

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. DANIEL E VARANAUSKI
Credential	:	D.N.
Telephone Number	:	773-972-6566

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/24/2008

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Directions to “LAKESHORE INTEGRATIVE HEALTHCARE, LTD ” Practice Location

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