MEDICARE: PHYSICIANS PLUS BERWYN 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	111NS0005X	Sports Physician Chiropractor	038009369	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01629928	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578748034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS PLUS BERWYN LTD.

Provider Business Mailing Address
First Line	:	205 W RANDOLPH ST
Second Line	:	1205
City	:	CHICAGO
State	:	IL
Zip	:	60606-1867
Country	:	US
Telephone Number	:	312-265-6908
Fax Number	:	312-264-0347

Provider Business Practice Location Address
First Line	:	205 W RANDOLPH ST
Second Line	:	1205
City	:	CHICAGO
State	:	IL
Zip	:	60606-1867
Country	:	US
Telephone Number	:	312-265-6908
Fax Number	:	312-264-0347

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. SCOTT SPENCER
Credential	:	D.C.
Telephone Number	:	312-265-6908

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	06/27/2013

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Directions to “PHYSICIANS PLUS BERWYN LTD. ” Practice Location

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