MEDICARE: AMERICAN CHIROPRACTIC & PAIN TREATMENT CENTER 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	111N00000X	Chiropractor	038008679	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01626681	OTHER	IL	BCBS PROVIDER NUMBER
2	038008679	OTHER	IL	LICENSE NUMBER

General Provider Information

NPI Number	:	1578642799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN CHIROPRACTIC & PAIN TREATMENT CENTER LTD

Provider Business Mailing Address
First Line	:	8951 W CERMAK RD
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1157
Country	:	US
Telephone Number	:	708-447-4800
Fax Number	:	708-447-0919

Provider Business Practice Location Address
First Line	:	8951 W CERMAK RD
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1157
Country	:	US
Telephone Number	:	708-447-4800
Fax Number	:	708-447-0919

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES R LOVELL
Credential	:	DC
Telephone Number	:	708-447-4800

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/09/2008

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