MEDICARE: HEALTHY CONNECTION HICKORY HILLS INC

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	67773845	IL

General Provider Information

NPI Number	:	1932405040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY CONNECTION HICKORY HILLS INC

Provider Business Mailing Address
First Line	:	PO BOX 767
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-0767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8723 W 95TH ST
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1732
Country	:	US
Telephone Number	:	815-603-9684
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	VICTOR PUODZIUNAS
Credential	:
Telephone Number	:	815-603-9684

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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