MEDICARE: DR. SHAHAB YARISAIED 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	29531	CA

General Provider Information

NPI Number	:	1588738496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHAB YARISAIED D.C.

Provider Business Mailing Address
First Line	:	1196 S DE ANZA BLVD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3632
Country	:	US
Telephone Number	:	408-446-0351
Fax Number	:

Provider Business Practice Location Address
First Line	:	1196 S DE ANZA BLVD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3632
Country	:	US
Telephone Number	:	408-446-0351
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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