MEDICARE: DR. THERESA MARIE FLEEGE DC

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		IL

General Provider Information

NPI Number	:	1629148184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA MARIE FLEEGE DC

Provider Business Mailing Address
First Line	:	155 ORRINGTON CT
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-2119
Country	:	US
Telephone Number	:	847-732-4928
Fax Number	:	847-359-4199

Provider Business Practice Location Address
First Line	:	2168 PLUM GROVE RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1932
Country	:	US
Telephone Number	:	847-963-4894
Fax Number	:	847-359-4199

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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