MEDICARE: DR. DELLA L FAULKNER 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	19622	CA

General Provider Information

NPI Number	:	1730110172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELLA L FAULKNER D.C.

Provider Business Mailing Address
First Line	:	3249 MT DIABLO CT
Second Line	:	101- B
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4084
Country	:	US
Telephone Number	:	925-937-2225
Fax Number	:	925-937-6865

Provider Business Practice Location Address
First Line	:	3249 MT DIABLO CT
Second Line	:	101- B
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4084
Country	:	US
Telephone Number	:	925-937-2225
Fax Number	:	925-937-6865

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/10/2009

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