MEDICARE: WEBER 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	COR 716	CA

General Provider Information

NPI Number	:	1386703213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBER CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	322 N LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2518
Country	:	US
Telephone Number	:	323-935-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 N LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2518
Country	:	US
Telephone Number	:	323-935-9777
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. JENNIFER CUNHA BOTELHO
Credential	:	D.C.
Telephone Number	:	323-935-9777

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/14/2009

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