MEDICARE: DR. MICHAEL H DAWSON 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	DC19750	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC19750	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1114099199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL H DAWSON D.C.

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	82013 DOCTOR CARREON BLVD
Second Line	:	SUITE B
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-775-6966
Fax Number	:	760-342-6882

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/20/2010

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