MEDICARE: MR. DELL ROESSLER SR. L.AC

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	171100000X	Acupuncturist	198.000214	IL

General Provider Information

NPI Number	:	1982057519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DELL ROESSLER SR. L.AC

Provider Business Mailing Address
First Line	:	2090 LARKIN AVE
Second Line	:	SUITE 25
City	:	ELGIN
State	:	IL
Zip	:	60123-5845
Country	:	US
Telephone Number	:	847-888-3133
Fax Number	:	847-888-3136

Provider Business Practice Location Address
First Line	:	2090 LARKIN AVE
Second Line	:	SUITE 25
City	:	ELGIN
State	:	IL
Zip	:	60123-5845
Country	:	US
Telephone Number	:	847-888-3133
Fax Number	:	847-888-3136

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

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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