MEDICARE: DR STEPHEN A KOFF D.C. A CHIROPRACTIC CORPORATION

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	25247	CA

General Provider Information

NPI Number	:	1538358833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR STEPHEN A KOFF D.C. A CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	5949 CLEAR VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1207
Country	:	US
Telephone Number	:	310-980-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5949 CLEAR VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1207
Country	:	US
Telephone Number	:	310-980-0580
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN KOFF
Credential	:	DC
Telephone Number	:	310-980-0580

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	12/17/2008

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