MEDICARE: PAPE CHIROPRACTIC, INC.

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	DC25089	CA

General Provider Information

NPI Number	:	1356640387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAPE CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1956 WEBSTER ST
Second Line	:	SUITE 250
City	:	OAKLAND
State	:	CA
Zip	:	94612-2947
Country	:	US
Telephone Number	:	510-444-7000
Fax Number	:	510-444-7004

Provider Business Practice Location Address
First Line	:	1956 WEBSTER ST
Second Line	:	SUITE 250
City	:	OAKLAND
State	:	CA
Zip	:	94612-2947
Country	:	US
Telephone Number	:	510-444-7000
Fax Number	:	510-444-7004

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. ROBERT DAVID PAPE
Credential	:	D.C.
Telephone Number	:	510-444-7000

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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