MEDICARE: MIRIAM ESTHER VENDELBOSCH DC

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	DC15660	CA

General Provider Information

NPI Number	:	1316045057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM ESTHER VENDELBOSCH DC

Provider Business Mailing Address
First Line	:	5308 DERRY AVE
Second Line	:	SUITE K
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301
Country	:	US
Telephone Number	:	818-865-6247
Fax Number	:	818-889-1940

Provider Business Practice Location Address
First Line	:	5308 DERRY AVE
Second Line	:	SUITE K
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301
Country	:	US
Telephone Number	:	818-865-6247
Fax Number	:	818-889-1940

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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