MEDICARE: DR. GREGORY B HEYWOOD 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	11204	CA

General Provider Information

NPI Number	:	1568555142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY B HEYWOOD D.C.

Provider Business Mailing Address
First Line	:	9700 RIO VISTA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95837-1005
Country	:	US
Telephone Number	:	916-921-2806
Fax Number	:	916-927-2164

Provider Business Practice Location Address
First Line	:	225 30TH ST
Second Line	:	SUITE 208
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3359
Country	:	US
Telephone Number	:	916-444-8390
Fax Number	:	916-444-1938

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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