MEDICARE: AUDREY J EGAN 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	DC27049	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	694717	OTHER	CA	BLUE SHIELD
2	1032392	OTHER	CA	ASHP

General Provider Information

NPI Number	:	1023057866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY J EGAN D.C.

Provider Business Mailing Address
First Line	:	1505 PERSHING DR
Second Line	:	APT D
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94129-1078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 FILLMORE ST
Second Line	:	STE. 100
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3180
Country	:	US
Telephone Number	:	415-567-9995
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/09/2007

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