MEDICARE: DANIEL J FEDELI, D.C.,P.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	016-82529-36	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841414984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL J FEDELI, D.C.,P.C.

Provider Business Mailing Address
First Line	:	1165 N CLARK ST
Second Line	:	SUITE 602
City	:	CHICAGO
State	:	IL
Zip	:	60610-2702
Country	:	US
Telephone Number	:	312-787-7222
Fax Number	:	312-787-7227

Provider Business Practice Location Address
First Line	:	1165 N CLARK ST
Second Line	:	SUITE 602
City	:	CHICAGO
State	:	IL
Zip	:	60610-2702
Country	:	US
Telephone Number	:	312-787-7222
Fax Number	:	312-787-7227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL JOSEPH FEDELI
Credential	:	D.C.
Telephone Number	:	312-787-7222

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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