MEDICARE: DR. MONICA CISNEROS 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	111NN1001X	Nutrition Chiropractor	038012729	IL
2	111NR0400X	Rehabilitation Chiropractor	038012729	IL
3	111NS0005X	Sports Physician Chiropractor	038012729	IL
4	111NI0900X	Internist Chiropractor	038012729	IL

General Provider Information

NPI Number	:	1831596980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONICA CISNEROS D.C.

Provider Business Mailing Address
First Line	:	1 CAMBERLEY CT
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-4564
Country	:	US
Telephone Number	:	773-762-3333
Fax Number	:	773-922-5203

Provider Business Practice Location Address
First Line	:	2859 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-5095
Country	:	US
Telephone Number	:	773-762-3333
Fax Number	:	773-922-5203

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

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	08/07/2020

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