MEDICARE: DR. GREGORY RONALD ROYTMAN 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	038.013491	IL
2	111NR0400X	Rehabilitation Chiropractor	038.013491	IL

General Provider Information

NPI Number	:	1811537152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY RONALD ROYTMAN DC

Provider Business Mailing Address
First Line	:	1829 S CEDAR LAKE RD
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-5711
Country	:	US
Telephone Number	:	847-740-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 S CEDAR LAKE RD
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-5711
Country	:	US
Telephone Number	:	847-740-9200
Fax Number	:

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

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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