MEDICARE: DOUGLAS COLE CHIROPRACTIC INC

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	DC21656	CA

General Provider Information

NPI Number	:	1659381457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS COLE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	12930 VENTURA BLVD
Second Line	:	SUITE 226C
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2200
Country	:	US
Telephone Number	:	818-995-4472
Fax Number	:

Provider Business Practice Location Address
First Line	:	12930 VENTURA BLVD
Second Line	:	SUITE 226C
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2200
Country	:	US
Telephone Number	:	818-995-4472
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS COLE
Credential	:	DC
Telephone Number	:	818-995-4472

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/07/2008

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