MEDICARE: DR. ROMAN R HYSELL 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	DC 30052	CA

General Provider Information

NPI Number	:	1104857085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMAN R HYSELL DC

Provider Business Mailing Address
First Line	:	2216 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2232
Country	:	US
Telephone Number	:	559-875-3535
Fax Number	:	559-875-2337

Provider Business Practice Location Address
First Line	:	2514 JENSEN AVE STE 103
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2250
Country	:	US
Telephone Number	:	559-875-3535
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/22/2019

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