MEDICARE: DR. ANDRE CHRISTOPHER HINES DC

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	038011202	IL

General Provider Information

NPI Number	:	1730325317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE CHRISTOPHER HINES DC

Provider Business Mailing Address
First Line	:	PO BOX 5988
Second Line	:	DEPT. 20-5001
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5988
Country	:	US
Telephone Number	:	630-468-1831
Fax Number	:	630-468-1834

Provider Business Practice Location Address
First Line	:	1522 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2528
Country	:	US
Telephone Number	:	312-379-5000
Fax Number	:	312-379-5060

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

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/02/2009

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