MEDICARE: RISE BODYWORKSA BEALL CHIROPRACTIC CORP

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	DC031508	CA

General Provider Information

NPI Number	:	1124572003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE BODYWORKSA BEALL CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	930 CENTRAL AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-3406
Country	:	US
Telephone Number	:	408-984-2455
Fax Number	:	408-984-2456

Provider Business Practice Location Address
First Line	:	930 CENTRAL AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-3406
Country	:	US
Telephone Number	:	408-984-2455
Fax Number	:	408-984-2456

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	DR. DAMON CHARLES FRACH
Credential	:	P.H.D.
Telephone Number	:	408-478-5092

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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