MEDICARE: COMPREHENSIVE CHIROPRACTIC CENTER

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	:	1285842583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	1817 W BEVERLY BLVD
Second Line	:	SUITE B
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3935
Country	:	US
Telephone Number	:	323-721-7390
Fax Number	:	323-721-8513

Provider Business Practice Location Address
First Line	:	1817 W BEVERLY BLVD
Second Line	:	SUITE B
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3935
Country	:	US
Telephone Number	:	323-721-7390
Fax Number	:	323-721-8513

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WAYNE IRA WALBURN
Credential	:	D.C.
Telephone Number	:	323-721-7390

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	01/30/2009

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Directions to “COMPREHENSIVE CHIROPRACTIC CENTER ” Practice Location

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