MEDICARE: NIKOO JAVANMARDI 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	DC23186	CA

General Provider Information

NPI Number	:	1285776914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOO JAVANMARDI D.C.

Provider Business Mailing Address
First Line	:	417 GRAND AVE
Second Line	:	SUITE 101
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3639
Country	:	US
Telephone Number	:	650-871-1364
Fax Number	:	650-871-6612

Provider Business Practice Location Address
First Line	:	417 GRAND AVE
Second Line	:	SUITE 101
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3639
Country	:	US
Telephone Number	:	650-871-1364
Fax Number	:	650-871-6612

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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