MEDICARE: VITAL DIAGNOSTIC SERVICES INC.

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	:	1285966655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL DIAGNOSTIC SERVICES INC.

Provider Business Mailing Address
First Line	:	1223 WILSHIRE BLVD
Second Line	:	1511
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:	310-345-9049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 WILSHIRE BLVD
Second Line	:	1511
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:	310-345-9049
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MICHAEL S SINEL
Credential	:	M.D.
Telephone Number	:	310-345-9049

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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