MEDICARE: IRENE MA 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	038010963	IL

General Provider Information

NPI Number	:	1841515541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE MA D.C.

Provider Business Mailing Address
First Line	:	4361 N LINCOLN AVE
Second Line	:	UNIT 5
City	:	CHICAGO
State	:	IL
Zip	:	60618-1741
Country	:	US
Telephone Number	:	312-610-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	4361 N LINCOLN AVE
Second Line	:	UNIT 5
City	:	CHICAGO
State	:	IL
Zip	:	60618-1741
Country	:	US
Telephone Number	:	312-610-9757
Fax Number	:

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	02/26/2016

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