MEDICARE: DR. MARK LEWIS VINICK 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	DC18993	CA

General Provider Information

NPI Number	:	1326268269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LEWIS VINICK D.C.

Provider Business Mailing Address
First Line	:	1860 S ELENA AVE
Second Line	:	SUITE A
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5706
Country	:	US
Telephone Number	:	310-375-4325
Fax Number	:	310-373-9225

Provider Business Practice Location Address
First Line	:	1860 S ELENA AVE
Second Line	:	SUITE A
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5706
Country	:	US
Telephone Number	:	310-375-4325
Fax Number	:	310-373-9225

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	01/11/2012

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