MEDICARE: 6 ESSENTIALS INTEGRATIVE HEALTH

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	038011623	IL

General Provider Information

NPI Number	:	1992037600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	6 ESSENTIALS INTEGRATIVE HEALTH

Provider Business Mailing Address
First Line	:	11267 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	708-846-6993
Fax Number	:

Provider Business Practice Location Address
First Line	:	11267 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	708-846-6993
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MS. STACY GLODKOWSKI
Credential	:	LMT, CPT
Telephone Number	:	708-846-6993

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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