MEDICARE: JO ANN MERINO FRATER 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	16382	CA

General Provider Information

NPI Number	:	1053313684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANN MERINO FRATER DC

Provider Business Mailing Address
First Line	:	3515 SWEETWATER SPRINGS BLVD
Second Line	:	SUITE 4
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1049
Country	:	US
Telephone Number	:	619-660-6006
Fax Number	:	619-660-0356

Provider Business Practice Location Address
First Line	:	3515 SWEETWATER SPRINGS BLVD
Second Line	:	SUITE 4
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1049
Country	:	US
Telephone Number	:	619-660-6006
Fax Number	:	619-660-0356

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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