MEDICARE: DR. JOSHUA WELCH 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	31097	CA
2	111NP0017X	Pediatric Chiropractor	31097	CA

General Provider Information

NPI Number	:	1033526207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA WELCH D.C.

Provider Business Mailing Address
First Line	:	15520 ROCKFIELD BLVD A200
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-6705
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	3637 LARCH AVE STE 1
Second Line	:	SAFE HAVEN CHIROPRACTIC
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-8478
Country	:	US
Telephone Number	:	530-577-5433
Fax Number	:

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	11/03/2015

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