MEDICARE: DONALD BAUNE CHIROPRACTIC INC.

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	111NN0400X	Neurology Chiropractor	DC13277	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CV133A	OTHER	CA	GROUP PTAN
2	CV134Z	OTHER	CA	INDIVIDUAL PTAN
4	1861507204	OTHER	CA	INDIVIDUAL NPI
5	DC13277	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1205166675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD BAUNE CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	25409 NARBONNE AVE
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2125
Country	:	US
Telephone Number	:	310-325-6210
Fax Number	:	310-530-1913

Provider Business Practice Location Address
First Line	:	25409 NARBONNE AVE
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2125
Country	:	US
Telephone Number	:	310-325-6210
Fax Number	:	310-530-1913

Authorized Official
Title or Position	:	PRESIDENT/OWNER/PROVIDER
Name	:	DR. DONALD JERRY BAUNE
Credential	:	D.C.
Telephone Number	:	310-325-6210

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	12/02/2011

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