MEDICARE: MATTHEW SANICKI 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	DC28735	CA

General Provider Information

NPI Number	:	1225471584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW SANICKI CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	3020 CANON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2612
Country	:	US
Telephone Number	:	619-223-1617
Fax Number	:	619-223-1618

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	MATTHEW SANICKI
Credential	:	D.C.
Telephone Number	:	619-223-1617

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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