MEDICARE: DR. NATHAN SIVANANDA D.C.

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	DC022167	CA

General Provider Information

NPI Number	:	1992051650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN SIVANANDA D.C.

Provider Business Mailing Address
First Line	:	1180 S MOUNT SHASTA BLVD
Second Line	:	SUITE C
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2764
Country	:	US
Telephone Number	:	530-926-1072
Fax Number	:	530-926-1072

Provider Business Practice Location Address
First Line	:	1180 S MOUNT SHASTA BLVD
Second Line	:	SUITE C
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2764
Country	:	US
Telephone Number	:	530-926-1072
Fax Number	:	530-926-1072

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

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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