MEDICARE: DAVE CARRY GOODLIFE 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1205537347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVE CARRY GOODLIFE CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	2218 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-543-7779
Fax Number	:	844-314-9911

Provider Business Practice Location Address
First Line	:	2218 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-543-7779
Fax Number	:	844-314-9911

Authorized Official
Title or Position	:	PARTNER
Name	:	DAVID E CARRY
Credential	:	MD
Telephone Number	:	310-543-7779

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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