MEDICARE: DR. JOHN EDWARD COLEMAN II 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	CA25557	CA

General Provider Information

NPI Number	:	1750500112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD COLEMAN II D.C.

Provider Business Mailing Address
First Line	:	2355 SAN RAMON VALLEY BLVD
Second Line	:	#102
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1523
Country	:	US
Telephone Number	:	925-406-4344
Fax Number	:	925-406-4408

Provider Business Practice Location Address
First Line	:	2355 SAN RAMON VALLEY BLVD
Second Line	:	#102
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1523
Country	:	US
Telephone Number	:	925-406-4344
Fax Number	:	925-406-4408

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/15/2012

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