MEDICARE: WITHERS 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	DC25028	CA

General Provider Information

NPI Number	:	1871985432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITHERS CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD STE B220
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-6703
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	4418 VINELAND AVE STE 218
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2159
Country	:	US
Telephone Number	:	818-275-2243
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. ROY WITHERS
Credential	:	DC
Telephone Number	:	818-275-2243

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	04/29/2015

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