MEDICARE: DR. LAURIE J GOSSETT 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	DC19803	CA

General Provider Information

NPI Number	:	1215055066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE J GOSSETT DC

Provider Business Mailing Address
First Line	:	3319 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5601
Country	:	US
Telephone Number	:	510-582-5454
Fax Number	:	510-582-0937

Provider Business Practice Location Address
First Line	:	3319 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5601
Country	:	US
Telephone Number	:	510-582-5454
Fax Number	:	510-582-0937

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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