MEDICARE: MASSEY FAMILY CHIROPRACTIC & WELLNESS CENTER PC

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	038-010356	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532295	OTHER	IL	BLUE CROSS BLUS SHIELD

General Provider Information

NPI Number	:	1922047984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSEY FAMILY CHIROPRACTIC & WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	2435 DEAN STREET
Second Line	:	UNIT D
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4827
Country	:	US
Telephone Number	:	630-444-1599
Fax Number	:	630-444-1825

Provider Business Practice Location Address
First Line	:	2435 DEAN STREET
Second Line	:	UNIT D
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4827
Country	:	US
Telephone Number	:	630-444-1599
Fax Number	:	630-444-1825

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIN ELIZABETH MASSEY
Credential	:	DC
Telephone Number	:	630-444-1599

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/04/2011

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