MEDICARE: THONGVICHIT CHIROPRACTIC CENTER

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	DC15050	CA
2	111N00000X	Chiropractor	DC29822	CA
3	111N00000X	Chiropractor	DC16156	CA

General Provider Information

NPI Number	:	1376723544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THONGVICHIT CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	4736 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2757
Country	:	US
Telephone Number	:	415-587-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4736 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2757
Country	:	US
Telephone Number	:	415-587-1500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUPIN THONGVICHIT
Credential	:	D.C.
Telephone Number	:	415-587-1500

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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