MEDICARE: DR. JAMES JOSEPH O'NEAL 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	16786	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1941812	OTHER	CA	MEDI-CAL PIN #

General Provider Information

NPI Number	:	1104985068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES JOSEPH O'NEAL D.C.

Provider Business Mailing Address
First Line	:	1007 W COLLEGE AVE STE C
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5046
Country	:	US
Telephone Number	:	707-575-3444
Fax Number	:	707-575-8943

Provider Business Practice Location Address
First Line	:	1007 W COLLEGE AVE STE C
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5046
Country	:	US
Telephone Number	:	707-575-3444
Fax Number	:	707-575-8943

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	10/28/2008

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