MEDICARE: CAFE OF LIFE CHIROPRACTIC PC

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	273340	OR

General Provider Information

NPI Number	:	1194911743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAFE OF LIFE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	519 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3216
Country	:	US
Telephone Number	:	541-389-3894
Fax Number	:	541-389-5004

Provider Business Practice Location Address
First Line	:	519 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3216
Country	:	US
Telephone Number	:	541-389-3894
Fax Number	:	541-389-5004

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DAVID RICHARD BOORSTEIN
Credential	:	DC
Telephone Number	:	541-389-3894

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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