MEDICARE: SUMMERS CHIROPRACTIC & WELLNESS CENTER, INC

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	305R00000X	Preferred Provider Organization	DC27667	CA

General Provider Information

NPI Number	:	1851619365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERS CHIROPRACTIC & WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	4418 VINELAND AVE STE 208
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4418 VINELAND AVE STE 208
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2159
Country	:	US
Telephone Number	:	818-985-4413
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CINDY ANNE SUMMERS
Credential	:
Telephone Number	:	818-985-4413

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/07/2010

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