MEDICARE: DR. MABEL M.P. CHAU D.C., L.AC.

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	DC12630	CA
2	171100000X	Acupuncturist	AC14257	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC14257	OTHER	CA	ACUPUNCTURE
2	DC12630	OTHER	CA	CHIROPRACTIC

General Provider Information

NPI Number	:	1225177876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MABEL M.P. CHAU D.C., L.AC.

Provider Business Mailing Address
First Line	:	1415 E COLORADO ST STE 209
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1541
Country	:	US
Telephone Number	:	818-956-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 E COLORADO ST STE 209
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1541
Country	:	US
Telephone Number	:	818-956-5165
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/22/2011

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