MEDICARE: DR. JOHN E MIN 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	25353	CA

General Provider Information

NPI Number	:	1457415929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E MIN D.C.

Provider Business Mailing Address
First Line	:	12732 W WASHINGTON BLVD
Second Line	:	SUITE D
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-301-0558
Fax Number	:	310-301-8460

Provider Business Practice Location Address
First Line	:	12732 W WASHINGTON BLVD
Second Line	:	SUITE D
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-301-0558
Fax Number	:	310-301-8460

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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