MEDICARE: BARTLETT CHIROPRACTIC CLINIC, S.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	038010561	IL

General Provider Information

NPI Number	:	1700132891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTLETT CHIROPRACTIC CLINIC, S.C.

Provider Business Mailing Address
First Line	:	138 S OAK AVE
Second Line	:
City	:	BARTLETT
State	:	IL
Zip	:	60103-6620
Country	:	US
Telephone Number	:	630-830-1500
Fax Number	:	630-830-2513

Provider Business Practice Location Address
First Line	:	138 S OAK AVE
Second Line	:
City	:	BARTLETT
State	:	IL
Zip	:	60103-6620
Country	:	US
Telephone Number	:	630-830-1500
Fax Number	:	630-830-2513

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH CHARLES RICHARD
Credential	:	DC
Telephone Number	:	630-830-1500

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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