MEDICARE: DR. MICHAEL SANJOSE 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	111NS0005X	Sports Physician Chiropractor	25502	CA
2	111N00000X	Chiropractor	25502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336414028	OTHER		NPI

General Provider Information

NPI Number	:	1538233119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SANJOSE D.C

Provider Business Mailing Address
First Line	:	2179 HARBOR BAY PKWY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-522-8051
Fax Number	:	510-259-1887

Provider Business Practice Location Address
First Line	:	2179 HARBOR BAY PKWY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-522-8051
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	08/17/2022

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