MEDICARE: MASROUR & HAROUNI CHIROPRACTIC, 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	:	1316589021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASROUR & HAROUNI CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 55458
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91413-0458
Country	:	US
Telephone Number	:	818-461-0790
Fax Number	:	818-461-1879

Provider Business Practice Location Address
First Line	:	18265 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91387-3532
Country	:	US
Telephone Number	:	661-252-7246
Fax Number	:	661-252-7247

Authorized Official
Title or Position	:	BILLER
Name	:	MS. PATRICIA GREEN
Credential	:
Telephone Number	:	805-231-1380

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	10/14/2019

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