MEDICARE: DAVID JOSEPH MINER DC

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	DC0214440	CA

General Provider Information

NPI Number	:	1649294919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOSEPH MINER DC

Provider Business Mailing Address
First Line	:	16320 TISH-A-TANG RD
Second Line	:
City	:	LOWER LAKE
State	:	CA
Zip	:	95457-0815
Country	:	US
Telephone Number	:	707-994-5204
Fax Number	:	707-994-7924

Provider Business Practice Location Address
First Line	:	16320 TISHATANG RD
Second Line	:
City	:	LOWER LAKE
State	:	CA
Zip	:	95457-0815
Country	:	US
Telephone Number	:	707-994-5204
Fax Number	:	707-994-7924

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/07/2016

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