MEDICARE: DR. WILLIAM W CHAN 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	DC15164	CA

General Provider Information

NPI Number	:	1609963438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM W CHAN D.C.

Provider Business Mailing Address
First Line	:	1111 E. LAS TUNAS DR.
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 E. LAS TUNAS DR.
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776
Country	:	US
Telephone Number	:	626-286-3323
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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