MEDICARE: DR. VINCE GUAGLIANO DC

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	23265	CA

General Provider Information

NPI Number	:	1386811867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCE GUAGLIANO DC

Provider Business Mailing Address
First Line	:	2407 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2913
Country	:	US
Telephone Number	:	310-796-6955
Fax Number	:	310-545-9588

Provider Business Practice Location Address
First Line	:	2407 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2913
Country	:	US
Telephone Number	:	310-796-6955
Fax Number	:	310-545-9588

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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