MEDICARE: MENNER CHIROPRACTIC, LLC

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	038006436	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4923238	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1720201957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENNER CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	110 S WYNSTONE PARK DR
Second Line	:	SUITE 105
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-6979
Country	:	US
Telephone Number	:	847-540-6060
Fax Number	:	847-277-8012

Provider Business Practice Location Address
First Line	:	110 S WYNSTONE PARK DR
Second Line	:	SUITE 105
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-6979
Country	:	US
Telephone Number	:	847-540-6060
Fax Number	:	847-277-8012

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID J MENNER
Credential	:	D.C.
Telephone Number	:	847-540-6060

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	09/21/2012

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Directions to “MENNER CHIROPRACTIC, LLC ” Practice Location

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