MEDICARE: DR. MARK ALAN CHADWELL 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	13481	CA

General Provider Information

NPI Number	:	1154521680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN CHADWELL D.C.

Provider Business Mailing Address
First Line	:	4040 CORTEZ WAY
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1620
Country	:	US
Telephone Number	:	619-303-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	8095 BROADWAY
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-2533
Country	:	US
Telephone Number	:	619-460-2805
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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