MEDICARE: KOEHLER CHIROPRACTIC CENTER PC

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	305R00000X	Preferred Provider Organization	038-005194	IL

General Provider Information

NPI Number	:	1568690717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOEHLER CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	4236 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1605
Country	:	US
Telephone Number	:	773-545-3700
Fax Number	:	773-545-0012

Provider Business Practice Location Address
First Line	:	4236 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1605
Country	:	US
Telephone Number	:	773-545-3700
Fax Number	:	773-545-0012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL KOEHLER
Credential	:	D.C.
Telephone Number	:	773-545-3700

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	06/30/2009

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