MEDICARE: PACK CHIROPRACTICE, 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	CA-30341	CA

General Provider Information

NPI Number	:	1548319098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACK CHIROPRACTICE, INC

Provider Business Mailing Address
First Line	:	4035 N FRESNO ST
Second Line	:	SUITE 103
City	:	FRESNO
State	:	CA
Zip	:	93726-4042
Country	:	US
Telephone Number	:	559-227-5307
Fax Number	:	559-227-3708

Provider Business Practice Location Address
First Line	:	4035 N FRESNO ST
Second Line	:	SUITE 103
City	:	FRESNO
State	:	CA
Zip	:	93726-4042
Country	:	US
Telephone Number	:	559-227-5307
Fax Number	:	559-227-3708

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAUN ROBERT MATSUMOTO
Credential	:	DC
Telephone Number	:	559-227-5307

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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Directions to “PACK CHIROPRACTICE, INC ” Practice Location

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