MEDICARE: BRIDGET MONAGHAN DC

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	038011670	IL

General Provider Information

NPI Number	:	1922300763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET MONAGHAN DC

Provider Business Mailing Address
First Line	:	PO BOX 5977
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5977
Country	:	US
Telephone Number	:	630-468-1831
Fax Number	:	630-468-1824

Provider Business Practice Location Address
First Line	:	1300 E 47TH ST
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60653-4508
Country	:	US
Telephone Number	:	773-332-1123
Fax Number	:	773-332-1126

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	11/30/2010

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