MEDICARE: NANCY DIBENEDETTO 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633246	OTHER	IL	BLUE SHIELD PROVIDER NUMB

General Provider Information

NPI Number	:	1760595284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY DIBENEDETTO D.C.

Provider Business Mailing Address
First Line	:	4045 N DAMEN AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3059
Country	:	US
Telephone Number	:	773-296-2766
Fax Number	:	773-296-2768

Provider Business Practice Location Address
First Line	:	4045 N DAMEN AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3059
Country	:	US
Telephone Number	:	773-296-2766
Fax Number	:	773-296-2768

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/09/2007

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