MEDICARE: DR. PRITPAL S SIDHU 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	22855	CA

General Provider Information

NPI Number	:	1861607947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRITPAL S SIDHU DC

Provider Business Mailing Address
First Line	:	165 W HOSPITALITY LN
Second Line	:	20
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3334
Country	:	US
Telephone Number	:	909-890-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 W HOSPITALITY LN
Second Line	:	20
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3334
Country	:	US
Telephone Number	:	909-890-0079
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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