MEDICARE: DARRYL LEE KLAWITTER DC

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	20255	CA

General Provider Information

NPI Number	:	1801993837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL LEE KLAWITTER DC

Provider Business Mailing Address
First Line	:	1905 FRANKLIN STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2905
Country	:	US
Telephone Number	:	510-433-0234
Fax Number	:	510-433-0116

Provider Business Practice Location Address
First Line	:	1905 FRANKLIN STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2905
Country	:	US
Telephone Number	:	510-433-0234
Fax Number	:	510-433-0116

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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