MEDICARE: DEL REY CHIROPRACTIC

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	261Q00000X	Clinic/Center	DC20537	CA

General Provider Information

NPI Number	:	1427504315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL REY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	800 PORTOLA DR STE B
Second Line	:
City	:	DEL REY OAKS
State	:	CA
Zip	:	93940-5530
Country	:	US
Telephone Number	:	831-393-2221
Fax Number	:	831-393-2411

Provider Business Practice Location Address
First Line	:	800 PORTOLA DR
Second Line	:	STE. B
City	:	DEL REY OAKS
State	:	CA
Zip	:	93940-5530
Country	:	US
Telephone Number	:	831-393-2221
Fax Number	:	831-393-2411

Authorized Official
Title or Position	:	OWNERR
Name	:	DR. GARY JAMES CAMPANARO
Credential	:	D.C.
Telephone Number	:	831-393-2221

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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Directions to “DEL REY CHIROPRACTIC ” Practice Location

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