MEDICARE: DENISE MATHRE CHIROPRACTIC CORPORATION

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	DC24828	CA

General Provider Information

NPI Number	:	1346662269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENISE MATHRE CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	12150 INDUSTRY BLVD STE 45
Second Line	:
City	:	JACKSON
State	:	CA
Zip	:	95642-9375
Country	:	US
Telephone Number	:	209-223-4442
Fax Number	:	209-231-5144

Provider Business Practice Location Address
First Line	:	12150 INDUSTRY BLVD STE 45
Second Line	:
City	:	JACKSON
State	:	CA
Zip	:	95642-9375
Country	:	US
Telephone Number	:	209-223-4442
Fax Number	:	209-231-5144

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DENISE MATHRE
Credential	:	DC
Telephone Number	:	209-223-4442

Provider Enumeration Date	:	01/12/2014
Last Update Date	:	01/12/2014

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