MEDICARE: DR. VIRGINIA ANN FREDERICK 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	DC18800	CA

General Provider Information

NPI Number	:	1124176433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA ANN FREDERICK D.C.

Provider Business Mailing Address
First Line	:	3740 HIDDEN SPRINGS CT
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-2145
Country	:	US
Telephone Number	:	510-262-9525
Fax Number	:	510-428-9450

Provider Business Practice Location Address
First Line	:	6434 TELEGRAPH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1112
Country	:	US
Telephone Number	:	510-482-9288
Fax Number	:	510-428-9450

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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