MEDICARE: BASISTA & LAU 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	DC21229	CA

General Provider Information

NPI Number	:	1578883211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASISTA & LAU CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	6940 SANTA TERESA BLVD
Second Line	:	SUITE 2
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1345
Country	:	US
Telephone Number	:	408-363-1991
Fax Number	:	408-363-1989

Provider Business Practice Location Address
First Line	:	6940 SANTA TERESA BLVD
Second Line	:	SUITE 2
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1345
Country	:	US
Telephone Number	:	408-363-1991
Fax Number	:	408-363-1989

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID W BASISTA
Credential	:
Telephone Number	:	408-363-1991

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	11/21/2023

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