MEDICARE: NEELEY CHIROPRACTIC, INC.

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
2	111N00000X	Chiropractor	DC22098	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ66071Z	OTHER	CA	BLUE SHIELD CHIROGROUP #
2	ZZZ66072Z	OTHER	CA	BLUE SHIELD PT GROUP #

General Provider Information

NPI Number	:	1073698759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEELEY CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	12925 EL CAMINO REAL
Second Line	:	SUITE J24
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1893
Country	:	US
Telephone Number	:	858-755-0808
Fax Number	:	858-755-7290

Provider Business Practice Location Address
First Line	:	12925 EL CAMINO REAL
Second Line	:	SUITE J24
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1893
Country	:	US
Telephone Number	:	858-755-0808
Fax Number	:	858-755-7290

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	MS. KORBY J MILLER
Credential	:
Telephone Number	:	702-475-8050

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/22/2010

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Directions to “NEELEY CHIROPRACTIC, INC. ” Practice Location

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