MEDICARE: MS. DANA AKHMETOVA 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	X010740	NY

General Provider Information

NPI Number	:	1285855817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA AKHMETOVA D.C.

Provider Business Mailing Address
First Line	:	3900 BAILEY AVE
Second Line	:	# 4C
City	:	BRONX
State	:	NY
Zip	:	10463-2736
Country	:	US
Telephone Number	:	917-459-5157
Fax Number	:	347-275-5719

Provider Business Practice Location Address
First Line	:	3900 BAILEY AVE
Second Line	:	# 4C
City	:	BRONX
State	:	NY
Zip	:	10463-2736
Country	:	US
Telephone Number	:	917-459-5157
Fax Number	:	347-275-5719

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/02/2008

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