MEDICARE: DR. KHOI BA TA III CHIROPRACTOR

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	25627	CA

General Provider Information

NPI Number	:	1316991284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHOI BA TA III CHIROPRACTOR

Provider Business Mailing Address
First Line	:	5850 STOCKTON BLVD
Second Line	:	SUITE B
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-3016
Country	:	US
Telephone Number	:	916-427-8200
Fax Number	:	916-391-6087

Provider Business Practice Location Address
First Line	:	5850 STOCKTON BLVD
Second Line	:	SUITE B
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-3016
Country	:	US
Telephone Number	:	916-427-8200
Fax Number	:	916-391-6087

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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