MEDICARE: NOLAN CHIROPRACTIC INCORPORATED

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	DC24771	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1972632412	OTHER	CA	INDIVIDUAL NPI
2	DC24771	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1629203757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLAN CHIROPRACTIC INCORPORATED

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	438 E KATELLA AVE
Second Line	:	SUITE L
City	:	ORANGE
State	:	CA
Zip	:	92867-4839
Country	:	US
Telephone Number	:	714-633-5521
Fax Number	:	714-633-8766

Authorized Official
Title or Position	:	PROVIDER / OWNER
Name	:	DR. ROBERT B NOLAN
Credential	:	D.C.
Telephone Number	:	714-633-5521

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	01/28/2011

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Directions to “NOLAN CHIROPRACTIC INCORPORATED ” Practice Location

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