MEDICARE: ALLIANCE CHIROPRACTIC HEALTH CENTER 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	038-009043	IL
2	111NS0005X	Sports Physician Chiropractor	038008973	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01630039	OTHER	IL	BCBS CASTILLO & REYES

General Provider Information

NPI Number	:	1942428644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE CHIROPRACTIC HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	4539 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2116
Country	:	US
Telephone Number	:	773-878-2660
Fax Number	:	773-878-2860

Provider Business Practice Location Address
First Line	:	4539 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2116
Country	:	US
Telephone Number	:	773-878-2660
Fax Number	:	773-878-2860

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIRGILIO C CASTILLO JR.
Credential	:	D.C.
Telephone Number	:	773-878-2660

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	09/02/2011

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