MEDICARE: CHIROPRACTIC CONNECTION 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	038-008863	IL

General Provider Information

NPI Number	:	1679796973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CONNECTION LTD

Provider Business Mailing Address
First Line	:	1440 W NORTH AVE
Second Line	:	SUITE 307
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 W NORTH AVE
Second Line	:	SUITE 307
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1422
Country	:	US
Telephone Number	:	708-345-1299
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK ZID
Credential	:	DC
Telephone Number	:	708-345-1299

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	02/11/2011

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