MEDICARE: DR. PETER SEGUINOT 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	CA29917	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EK418A	OTHER	CA	MEDICARE-PTAN

General Provider Information

NPI Number	:	1255532065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER SEGUINOT D.C.

Provider Business Mailing Address
First Line	:	1707 GRAND AVE
Second Line	:	SUITE#2
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-273-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 GRAND AVE
Second Line	:	SUITE #2
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-273-6700
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	01/23/2012

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