MEDICARE: SPRINGBACK CHIROPRACTIC

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

General Provider Information

NPI Number	:	1821556366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGBACK CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7316 SANTA MONICA BLVD APT 647
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7316 SANTA MONICA BLVD APT 647
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6685
Country	:	US
Telephone Number	:	760-717-4332
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	PATRICK BAIN
Credential	:	D.C
Telephone Number	:	760-717-4332

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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Directions to “SPRINGBACK CHIROPRACTIC ” Practice Location

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