MEDICARE: LOS QUIROPRACTICOS, LLC

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	24189	IL

General Provider Information

NPI Number	:	1962689257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS QUIROPRACTICOS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 5603
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93031-5603
Country	:	US
Telephone Number	:	805-487-4043
Fax Number	:	805-487-4003

Provider Business Practice Location Address
First Line	:	3225 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4032
Country	:	US
Telephone Number	:	773-376-0600
Fax Number	:	773-376-0602

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MCHAEL SHOAR
Credential	:	D.C.
Telephone Number	:	805-487-4043

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	03/18/2009

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