MEDICARE: NICOLE TATSUGUCHI-ONGCAL DC

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	038.014158	IL

General Provider Information

NPI Number	:	1982440087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TATSUGUCHI-ONGCAL DC

Provider Business Mailing Address
First Line	:	150 W SAINT CHARLES RD APT 508
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-2279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 N SOUTHPORT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1436
Country	:	US
Telephone Number	:	773-248-2544
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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