MEDICARE: PAIN STOP CHIROMASSAGE 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	038011403	IL

General Provider Information

NPI Number	:	1639437817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN STOP CHIROMASSAGE LTD.

Provider Business Mailing Address
First Line	:	1326 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9148
Country	:	US
Telephone Number	:	773-342-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9148
Country	:	US
Telephone Number	:	773-342-2081
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HEE CHUL CHOI
Credential	:	D.C.
Telephone Number	:	773-342-2081

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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