MEDICARE: UPLAND SPINE & REHAB

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	111N00000X	Chiropractor	32005	CA

General Provider Information

NPI Number	:	1477829885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLAND SPINE & REHAB

Provider Business Mailing Address
First Line	:	1125 E 16TH ST
Second Line	:	SUITE 4
City	:	UPLAND
State	:	CA
Zip	:	91784-9179
Country	:	US
Telephone Number	:	909-297-3531
Fax Number	:	909-297-3004

Provider Business Practice Location Address
First Line	:	1125 E 16TH ST
Second Line	:	SUITE 4
City	:	UPLAND
State	:	CA
Zip	:	91784-9179
Country	:	US
Telephone Number	:	909-297-3531
Fax Number	:	909-297-3004

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. SENKOSAL UY
Credential	:	D.C.
Telephone Number	:	909-297-3531

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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Directions to “UPLAND SPINE & REHAB ” Practice Location

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