MEDICARE: MR. NORMAN DEITCH DC

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	DC27040	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007357745	OTHER	CA	AETNA
2	671144	OTHER	CA	CONNECTICARE
3	ZZZ66356Z	OTHER	CA	BLUE SHIELD
4	ZZZ09734Z	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1568548113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORMAN DEITCH DC

Provider Business Mailing Address
First Line	:	2125 S EL CAMINO REAL
Second Line	:	SUITE 210
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-231-1116
Fax Number	:	760-231-6429

Provider Business Practice Location Address
First Line	:	2125 S EL CAMINO REAL
Second Line	:	SUITE 210
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-231-1116
Fax Number	:	760-231-6429

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	02/04/2009

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Directions to “ MR. NORMAN DEITCH DC” Practice Location

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