MEDICARE: DR. SHINICHI KINO D.C.

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	30411	CA

General Provider Information

NPI Number	:	1225164551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHINICHI KINO D.C.

Provider Business Mailing Address
First Line	:	1707 GRAND AVE STE 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-866-4545
Fax Number	:	858-273-6702

Provider Business Practice Location Address
First Line	:	1707 GRAND AVE STE 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-866-4545
Fax Number	:	858-273-6702

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	05/13/2010

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