MEDICARE: J.R. ROSSER, JR. D.C, S.C.

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	038-003342	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4515124	OTHER	IL	BCBS IL

General Provider Information

NPI Number	:	1932380607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.R. ROSSER, JR. D.C, S.C.

Provider Business Mailing Address
First Line	:	1276 W SPRING ST
Second Line	:	SUITE B
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3304
Country	:	US
Telephone Number	:	847-741-6400
Fax Number	:	847-741-6926

Provider Business Practice Location Address
First Line	:	1276 W SPRING ST
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3304
Country	:	US
Telephone Number	:	847-741-6400
Fax Number	:	847-741-6926

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN R. ROSSER
Credential	:	D.C.
Telephone Number	:	847-741-6400

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	01/21/2014

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