MEDICARE: TOTAL BODY 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	273Y00000X	Rehabilitation Hospital Unit	DC31626	CA

General Provider Information

NPI Number	:	1457655029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL BODY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	11633 SAN VICENTE BLVD STE 214
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	310-562-5680
Fax Number	:	310-826-9894

Provider Business Practice Location Address
First Line	:	11633 SAN VICENTE BLVD STE 214
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	310-562-5680
Fax Number	:	310-826-9894

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. SUZANNE ALICIA CHAVEZ
Credential	:	D.C.
Telephone Number	:	310-562-5680

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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