MEDICARE: EAST YOLO CHIROPRACTIC CENTER, INC

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	DC15942	CA

General Provider Information

NPI Number	:	1467446781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST YOLO CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	2939 W CAPITOL AVE
Second Line	:
City	:	W SACRAMENTO
State	:	CA
Zip	:	95691-2910
Country	:	US
Telephone Number	:	916-371-7882
Fax Number	:	916-371-7897

Provider Business Practice Location Address
First Line	:	2939 W CAPITOL AVE
Second Line	:
City	:	W SACRAMENTO
State	:	CA
Zip	:	95691-2910
Country	:	US
Telephone Number	:	916-371-7882
Fax Number	:	916-371-7897

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT EUGENE HARRISON
Credential	:	DC
Telephone Number	:	916-371-7882

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/22/2020

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