MEDICARE: LONG BEACH SPINE & REHABILITATION

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	111NS0005X	Sports Physician Chiropractor	DC24681	CA

General Provider Information

NPI Number	:	1447524806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH SPINE & REHABILITATION

Provider Business Mailing Address
First Line	:	3434 N.LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2915
Country	:	US
Telephone Number	:	562-938-8770
Fax Number	:	562-938-8762

Provider Business Practice Location Address
First Line	:	3434 N.LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2915
Country	:	US
Telephone Number	:	562-938-8770
Fax Number	:	562-938-8762

Authorized Official
Title or Position	:	DR. MARTA CALLOTTA DC, CCSP / OWNER
Name	:	MARTA LYNN CALLOTTA
Credential	:	DC, CCSP
Telephone Number	:	562-938-8770

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	05/04/2017

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Directions to “LONG BEACH SPINE & REHABILITATION ” Practice Location

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