MEDICARE: MRS. YULIA KISELEV 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	DC26422	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0264220	OTHER	CA	TIN IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1316167869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YULIA KISELEV D.C.

Provider Business Mailing Address
First Line	:	561 DRISCOLL PL
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-4056
Country	:	US
Telephone Number	:	650-856-8849
Fax Number	:	650-856-8849

Provider Business Practice Location Address
First Line	:	4962 EL CAMINO REAL
Second Line	:	STE. 204
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1454
Country	:	US
Telephone Number	:	650-210-8981
Fax Number	:	650-210-0070

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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