MEDICARE: DR. CONSTANCE ANN BLACK 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01682433	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1841366721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE ANN BLACK DC

Provider Business Mailing Address
First Line	:	6044 N LANDERS
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5614
Country	:	US
Telephone Number	:	773-774-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 SHERMAN AVE
Second Line	:	STE 204
City	:	EVANSTON
State	:	IL
Zip	:	60201-3753
Country	:	US
Telephone Number	:	847-328-2008
Fax Number	:	847-328-8171

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CONSTANCE ANN BLACK DC” Practice Location

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