MEDICARE: DR. SAMIR FARAH DAHER 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	111NX0100X	Occupational Health Chiropractor	DC16112	CA

General Provider Information

NPI Number	:	1699749093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR FARAH DAHER D.C.

Provider Business Mailing Address
First Line	:	319 S BRAND BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1701
Country	:	US
Telephone Number	:	818-507-5339
Fax Number	:	818-246-2170

Provider Business Practice Location Address
First Line	:	319 S BRAND BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1701
Country	:	US
Telephone Number	:	818-507-5339
Fax Number	:	818-246-2170

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	01/21/2008

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