MEDICARE: DR. RICHARD VAN TIL 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	038-010127	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4632052	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730184862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD VAN TIL D.C.

Provider Business Mailing Address
First Line	:	404 S KENNEDY DR
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-2137
Country	:	US
Telephone Number	:	815-929-9296
Fax Number	:	815-929-9667

Provider Business Practice Location Address
First Line	:	404 S KENNEDY DR
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-2137
Country	:	US
Telephone Number	:	815-929-9296
Fax Number	:	815-929-9667

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/09/2025

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