MEDICARE: MODERN HEALTH & BODY INC

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	038011455	IL

General Provider Information

NPI Number	:	1841604386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN HEALTH & BODY INC

Provider Business Mailing Address
First Line	:	4045 N DAMEN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60618-3148
Country	:	US
Telephone Number	:	773-296-2766
Fax Number	:

Provider Business Practice Location Address
First Line	:	4045 N DAMEN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60618-3148
Country	:	US
Telephone Number	:	773-296-2766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KRYSTEN TATAREK
Credential	:	DC
Telephone Number	:	773-782-7410

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	08/04/2014

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Directions to “MODERN HEALTH & BODY INC ” Practice Location

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