MEDICARE: DR. MARIO SKILES GUTIERREZ 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	DC29728	CA

General Provider Information

NPI Number	:	1083624795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO SKILES GUTIERREZ D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1549
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95763-1549
Country	:	US
Telephone Number	:	916-853-2002
Fax Number	:	916-853-2009

Provider Business Practice Location Address
First Line	:	2286 SUNRISE BLVD
Second Line	:
City	:	GOLD RIVER
State	:	CA
Zip	:	95670-4342
Country	:	US
Telephone Number	:	916-853-2002
Fax Number	:	916-853-2009

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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