MEDICARE: LILES CHIROPRACTIC CLINIC LTD.

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	01582005	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1881768737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILES CHIROPRACTIC CLINIC LTD.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-0424
Country	:	US
Telephone Number	:	815-369-4974
Fax Number	:	815-369-4975

Provider Business Practice Location Address
First Line	:	238 W MAIN ST.
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9770
Country	:	US
Telephone Number	:	815-369-4974
Fax Number	:	815-369-4975

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES T LILES
Credential	:	D.C.
Telephone Number	:	815-369-4974

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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