MEDICARE: WELBORN CHIROPRACTIC CORPORATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174507701	OTHER	CA	IRS

General Provider Information

NPI Number	:	1295206928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELBORN CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	8700 AUBURN FOLSOM RD STE 300
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-8501
Country	:	US
Telephone Number	:	916-872-1120
Fax Number	:	916-872-1125

Provider Business Practice Location Address
First Line	:	8700 AUBURN FOLSOM RD STE 300
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-8501
Country	:	US
Telephone Number	:	916-872-1120
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHARINA CHRISTINE WELBORN
Credential	:	DC
Telephone Number	:	916-872-1120

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/30/2019

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