MEDICARE: MR. BARON ASHLEY SAMS DC

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	12045	CA

General Provider Information

NPI Number	:	1023108453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARON ASHLEY SAMS DC

Provider Business Mailing Address
First Line	:	5151 MURPHY CANYON RD
Second Line	:	200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4440
Country	:	US
Telephone Number	:	858-569-6959
Fax Number	:	858-569-0240

Provider Business Practice Location Address
First Line	:	5151 MURPHY CANYON RD
Second Line	:	200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4440
Country	:	US
Telephone Number	:	858-569-6959
Fax Number	:	858-569-0240

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

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	12/20/2013

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