MEDICARE: ROSENCRANS CHIROPRACTIC, 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	111N00000X	Chiropractor	DC 256614	CA

General Provider Information

NPI Number	:	1477880128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSENCRANS CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	2700 WEST COAST HWY
Second Line	:	SUITE 234
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663
Country	:	US
Telephone Number	:	949-631-1440
Fax Number	:	949-631-1410

Provider Business Practice Location Address
First Line	:	2700 W COAST HWY
Second Line	:	SUITE 234
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4725
Country	:	US
Telephone Number	:	949-631-1440
Fax Number	:	949-631-1410

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACQUI LYNN ROSENCRANS
Credential	:	DC
Telephone Number	:	949-631-1440

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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