MEDICARE: DARNALL AND ASSOCIATES

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	111NX0800X	Orthopedic Chiropractor	15173	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC 0151730	OTHER		MEDICARE ID

General Provider Information

NPI Number	:	1407179310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARNALL AND ASSOCIATES

Provider Business Mailing Address
First Line	:	2308 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5506
Country	:	US
Telephone Number	:	209-462-2759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5506
Country	:	US
Telephone Number	:	209-462-2759
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. JAMES EDGAR DARNALL
Credential	:	D.C.
Telephone Number	:	209-462-2759

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	03/05/2010

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