MEDICARE: DR. JAMES T LILES D.C.

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		IL

General Provider Information

NPI Number	:	1972574689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES T LILES D.C.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-0424
Country	:	US
Telephone Number	:	815-369-4974
Fax Number	:	815-369-4975

Provider Business Practice Location Address
First Line	:	238 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-0424
Country	:	US
Telephone Number	:	815-369-4974
Fax Number	:	815-369-4975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/09/2007

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