=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992892376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY LYNN SCECINA DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16801 VAN BUREN BLVD SUITE D
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504-5896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-780-8833
-----------------------------------------------------
Fax | 951-780-9368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16801 VAN BUREN BLVD SUITE D
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504-5896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-780-8833
-----------------------------------------------------
Fax | 951-780-9368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 12048
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------