MEDICARE: CALLISTA C LAY LTD

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	038012202	IL

General Provider Information

NPI Number	:	1952657991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLISTA C LAY LTD

Provider Business Mailing Address
First Line	:	917 W WASHINGTON BLVD BOX 254
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607
Country	:	US
Telephone Number	:	312-491-8100
Fax Number	:	312-491-8105

Provider Business Practice Location Address
First Line	:	1169 W MADISON
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607
Country	:	US
Telephone Number	:	312-491-8100
Fax Number	:	312-491-8105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CALLISTA C LAY
Credential	:	DC
Telephone Number	:	312-491-8100

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	11/21/2016

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