MEDICARE: DR. JONATHAN A MACKOFF D.C.

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	111NR0400X	Rehabilitation Chiropractor	038-008553	IL

General Provider Information

NPI Number	:	1619125432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN A MACKOFF D.C.

Provider Business Mailing Address
First Line	:	730 N FRANKLIN ST
Second Line	:	SUITE 620
City	:	CHICAGO
State	:	IL
Zip	:	60654-3563
Country	:	US
Telephone Number	:	312-932-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 N FRANKLIN ST
Second Line	:	SUITE 620
City	:	CHICAGO
State	:	IL
Zip	:	60654-3563
Country	:	US
Telephone Number	:	312-932-0350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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