MEDICARE: BAINER CHIROPRACTIC 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	111N00000X	Chiropractor	DC24877	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1831114024	OTHER	CA	TYPE 1 NPI (INDIVIDUAL)

General Provider Information

NPI Number	:	1871711176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAINER CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	5006 SUNRISE BLVD STE 102
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4940
Country	:	US
Telephone Number	:	916-962-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 SUNRISE BLVD STE 102
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4940
Country	:	US
Telephone Number	:	916-962-3088
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARK CHARLES BAINER
Credential	:	D.C.
Telephone Number	:	916-962-3088

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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