MEDICARE: MOSHREFI CHIROPRACTIC CORPORATION

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	302R00000X	Health Maintenance Organization	DC-27824	CA

General Provider Information

NPI Number	:	1619115177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSHREFI CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	1450 UNIVERSITY AVE STE E
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-4411
Country	:	US
Telephone Number	:	951-222-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 UNIVERSITY AVE STE E
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-4411
Country	:	US
Telephone Number	:	951-222-2002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BEN MOSHREFI
Credential	:
Telephone Number	:	951-222-2002

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/21/2009

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