MEDICARE: MRS. MICHELE DOREEN CLEVELAND-BOSTEN 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	DC17611	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17611A	OTHER	CA	WDC

General Provider Information

NPI Number	:	1669589883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE DOREEN CLEVELAND-BOSTEN D.C.

Provider Business Mailing Address
First Line	:	3283 MOTOR AVENUE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034
Country	:	US
Telephone Number	:	310-559-6900
Fax Number	:	310-836-8664

Provider Business Practice Location Address
First Line	:	3283 MOTOR AVENUE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034
Country	:	US
Telephone Number	:	310-559-6900
Fax Number	:	310-836-8664

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	01/05/2015

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