MEDICARE: SANCHEZ CHIROPRACTIC WELLNESS CENTER PAIN MANAGEMENT

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	225100000X	Physical Therapist	PT 2966	CA
2	111N00000X	Chiropractor	DC 29588	CA

General Provider Information

NPI Number	:	1477507556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCHEZ CHIROPRACTIC WELLNESS CENTER PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	2516 SAMARITAN DR
Second Line	:	SUITE J
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4108
Country	:	US
Telephone Number	:	408-356-2061
Fax Number	:	408-356-2071

Provider Business Practice Location Address
First Line	:	2516 SAMARITAN DR
Second Line	:	SUITE J
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4108
Country	:	US
Telephone Number	:	408-356-2061
Fax Number	:	408-356-2071

Authorized Official
Title or Position	:	C.E.O
Name	:	DR. FREDY FERNANDO SANCHEZ
Credential	:	D.C., P.T
Telephone Number	:	408-356-2061

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	08/21/2013

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