MEDICARE: SALEM 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

General Provider Information

NPI Number	:	1740976422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	120 S DELMAR AVE STE B
Second Line	:
City	:	SALEM
State	:	IL
Zip	:	62881-2000
Country	:	US
Telephone Number	:	618-740-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S DELMAR AVE STE B
Second Line	:
City	:	SALEM
State	:	IL
Zip	:	62881-2000
Country	:	US
Telephone Number	:	618-740-1711
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE MANAGER
Name	:	MELISSA TAYLOR
Credential	:
Telephone Number	:	618-979-3326

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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