MEDICARE: NICHOLE CASTO 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	DC28482	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629219126	OTHER	CA	GROUP NPI
2	ZZZ53912Y	OTHER	CA	BLUE SHIELD
3	DC28482	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1427145911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE CASTO D.C.

Provider Business Mailing Address
First Line	:	15520 ROCKFIELD BLVD
Second Line	:	STE A200
City	:	IRVINE
State	:	CA
Zip	:	92618-6705
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	1156 EMERALD BAY RD
Second Line	:	C
City	:	S LAKE TAHOE
State	:	CA
Zip	:	96150
Country	:	US
Telephone Number	:	530-543-1201
Fax Number	:	530-543-1322

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/21/2020

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Directions to “ NICHOLE CASTO D.C.” Practice Location

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