MEDICARE: AFFINITY CHIROPRACTIC AND REHABILITATION, LLC

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	038.012205	IL

General Provider Information

NPI Number	:	1851631154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY CHIROPRACTIC AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	1518 E 63RD ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2921
Country	:	US
Telephone Number	:	312-225-1100
Fax Number	:	773-363-7822

Provider Business Practice Location Address
First Line	:	1518 E. 63RD ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2921
Country	:	US
Telephone Number	:	773-241-6600
Fax Number	:	773-363-7822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMIKO MICHELLE LIBURD
Credential	:
Telephone Number	:	630-885-0378

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	12/14/2015

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