MEDICARE: DESAI CHIROPRACTIC PROFESSIONAL CORPORATION

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	33011	CA
2	111N00000X	Chiropractor	32410	CA

General Provider Information

NPI Number	:	1265838569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESAI CHIROPRACTIC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	700 N PACIFIC COAST HWY
Second Line	:	STE. 302
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-734-2040
Fax Number	:	310-598-2040

Provider Business Practice Location Address
First Line	:	700 N PACIFIC COAST HWY
Second Line	:	STE. 302
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-734-2040
Fax Number	:	310-598-2040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSHANI DESAI
Credential	:	D.C.
Telephone Number	:	951-733-6194

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	05/21/2015

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