MEDICARE: DR. BORIS ENRIQUE DEL CID D.C.

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	DC20952	CA

General Provider Information

NPI Number	:	1548313117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORIS ENRIQUE DEL CID D.C.

Provider Business Mailing Address
First Line	:	707 CALLE MONSERRAT
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-2371
Country	:	US
Telephone Number	:	949-357-7477
Fax Number	:	949-361-4311

Provider Business Practice Location Address
First Line	:	33159 CAMINO CAPISTRANO
Second Line	:	SUITE D
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-4827
Country	:	US
Telephone Number	:	949-488-0016
Fax Number	:	949-488-0507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/01/2013

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