MEDICARE: RUBANENKO 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	DC26485	CA

General Provider Information

NPI Number	:	1174835474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBANENKO CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	5440 MOREHOUSE DR STE 1700
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-6703
Country	:	US
Telephone Number	:	858-455-7654
Fax Number	:	858-455-5014

Provider Business Practice Location Address
First Line	:	5440 MOREHOUSE DR STE 1700
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-6703
Country	:	US
Telephone Number	:	858-455-7654
Fax Number	:	858-455-5014

Authorized Official
Title or Position	:	MANAGER
Name	:	SERENA RODARTE
Credential	:
Telephone Number	:	760-414-9700

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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