MEDICARE: BLOOMINGDALE CHIROPRACTIC CLINIC

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	111NI0013X	Independent Medical Examiner Chiropractor		IL

General Provider Information

NPI Number	:	1962681080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMINGDALE CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	209 E ARMY TRAIL RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1758
Country	:	US
Telephone Number	:	630-980-5640
Fax Number	:	630-980-9835

Provider Business Practice Location Address
First Line	:	209 E ARMY TRAIL RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1758
Country	:	US
Telephone Number	:	630-980-5640
Fax Number	:	630-980-9835

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES A DEAN
Credential	:	D.C.
Telephone Number	:	630-980-5460

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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Directions to “BLOOMINGDALE CHIROPRACTIC CLINIC ” Practice Location

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