MEDICARE: DR. LINDA CRUZ 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	33398	CA
2	111N00000X	Chiropractor	12545	TX

General Provider Information

NPI Number	:	1679946305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA CRUZ D.C.

Provider Business Mailing Address
First Line	:	1180 S MOUNT SHASTA BLVD STE C
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2764
Country	:	US
Telephone Number	:	832-512-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 S MOUNT SHASTA BLVD STE C
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2764
Country	:	US
Telephone Number	:	832-512-7333
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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