=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114031986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARMAINE MAGALE D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2716 V STREET
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-551-1545
-----------------------------------------------------
Fax | 916-551-1545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6025 4TH AVE
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-529-2124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | DC28818
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------