MEDICARE: DR. STEVAN OSTOJIC 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	111N00000X	Chiropractor	038-006610	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001682330	OTHER	IL	B.C.B.S.

General Provider Information

NPI Number	:	1649357658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVAN OSTOJIC D.C.

Provider Business Mailing Address
First Line	:	6418 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-3921
Country	:	US
Telephone Number	:	773-777-6866
Fax Number	:	773-777-8531

Provider Business Practice Location Address
First Line	:	6418 W BELMONT AVE
Second Line	:	SUITE 102
City	:	CHICAGO
State	:	IL
Zip	:	60634-3921
Country	:	US
Telephone Number	:	773-777-6866
Fax Number	:	773-777-8531

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/22/2011

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