MEDICARE: NCC NATURAL CARE CHIROPRACTIC, SC

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

General Provider Information

NPI Number	:	1679207542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NCC NATURAL CARE CHIROPRACTIC, SC

Provider Business Mailing Address
First Line	:	2118 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-265-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-265-0600
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. NICOLE J GOPAUL
Credential	:	DC
Telephone Number	:	224-213-5876

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	10/12/2022

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