MEDICARE: RESTORATION HEALTHCARE

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	038012441	IL

General Provider Information

NPI Number	:	1588039903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION HEALTHCARE

Provider Business Mailing Address
First Line	:	733 HASTINGS DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6906
Country	:	US
Telephone Number	:	847-947-2194
Fax Number	:	847-346-1842

Provider Business Practice Location Address
First Line	:	733 HASTINGS DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6906
Country	:	US
Telephone Number	:	847-947-2194
Fax Number	:	847-346-1842

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ERIN MAYER
Credential	:	D.C
Telephone Number	:	847-947-2194

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/06/2016

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