MEDICARE: DAVID BORGES 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	13943	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0139430	OTHER	CA	BLUE CROSS PIN

General Provider Information

NPI Number	:	1053336453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BORGES DC

Provider Business Mailing Address
First Line	:	2074 LAKE TAHOE BLVD STE 5
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6408
Country	:	US
Telephone Number	:	530-544-5800
Fax Number	:	530-544-5802

Provider Business Practice Location Address
First Line	:	2074 LAKE TAHOE BLVD STE 5
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6408
Country	:	US
Telephone Number	:	530-544-5800
Fax Number	:	530-544-5802

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/08/2024

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Directions to “ DAVID BORGES DC” Practice Location

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