MEDICARE: TOTAL LOWBACK CARE MEDICAL GROUP

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	111NN1001X	Nutrition Chiropractor	DC12023	CA

General Provider Information

NPI Number	:	1457775355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL LOWBACK CARE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5336 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1005
Country	:	US
Telephone Number	:	323-467-5200
Fax Number	:	323-467-1952

Provider Business Practice Location Address
First Line	:	5336 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1005
Country	:	US
Telephone Number	:	323-467-5200
Fax Number	:	323-467-1952

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN D PRICE
Credential	:	D.C.
Telephone Number	:	323-467-5200

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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