MEDICARE: UPCHURCH 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	:	1245834951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPCHURCH CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	2893 MCGRAW ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6044
Country	:	US
Telephone Number	:	619-381-3759
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 MORENA BLVD STE 209A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3571
Country	:	US
Telephone Number	:	619-381-3759
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW RYAN UPCHURCH
Credential	:	DC
Telephone Number	:	619-381-3759

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	12/28/2020

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