MEDICARE: LUBA MEDVEDEV DC

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	DC26445	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205901535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBA MEDVEDEV DC

Provider Business Mailing Address
First Line	:	4927 ENGLEWOOD DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-4232
Country	:	US
Telephone Number	:	408-725-2691
Fax Number	:	408-725-0172

Provider Business Practice Location Address
First Line	:	1 BAYWOOD AVE STE 4
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1537
Country	:	US
Telephone Number	:	650-343-8512
Fax Number	:	408-725-0172

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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Directions to “ LUBA MEDVEDEV DC” Practice Location

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