MEDICARE: DR. CASEY S CHAN 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	DC29443	CA

General Provider Information

NPI Number	:	1841206877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY S CHAN DC

Provider Business Mailing Address
First Line	:	9871 CARMEL MOUNTAIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2811
Country	:	US
Telephone Number	:	858-484-0800
Fax Number	:	858-484-2813

Provider Business Practice Location Address
First Line	:	9871 CARMEL MOUNTAIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2811
Country	:	US
Telephone Number	:	858-484-0800
Fax Number	:	858-484-2813

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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