MEDICARE: DR. JUSTIN DAVID MCLEOD 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	30568	CA

General Provider Information

NPI Number	:	1053502930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN DAVID MCLEOD D.C.

Provider Business Mailing Address
First Line	:	4516 MUIRWOOD DR
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4300
Country	:	US
Telephone Number	:	801-358-3121
Fax Number	:	925-417-1056

Provider Business Practice Location Address
First Line	:	7575 SOQUEL DR
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3815
Country	:	US
Telephone Number	:	831-688-5156
Fax Number	:	831-661-0228

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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