MEDICARE: DR. MATT GOENNE 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	DC-27765	CA

General Provider Information

NPI Number	:	1255351029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT GOENNE D.C

Provider Business Mailing Address
First Line	:	4380 FELTON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1421
Country	:	US
Telephone Number	:	619-283-6001
Fax Number	:	619-283-1272

Provider Business Practice Location Address
First Line	:	4380 FELTON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1421
Country	:	US
Telephone Number	:	619-283-6001
Fax Number	:	619-283-1272

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. MATT GOENNE D.C” Practice Location

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