MEDICARE: MORGAN SEMENCHUK MPT

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	111NR0400X	Rehabilitation Chiropractor	33367	CA

General Provider Information

NPI Number	:	1245432525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN SEMENCHUK MPT

Provider Business Mailing Address
First Line	:	5 LUMB LN
Second Line	:
City	:	HYDE PARK
State	:	NY
Zip	:	12538-2211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 SOQUEL DR
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3815
Country	:	US
Telephone Number	:	831-688-5156
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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