MEDICARE: DR. HOMER EZEQUIEL FIRESTONE 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	34989	CA

General Provider Information

NPI Number	:	1598361859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOMER EZEQUIEL FIRESTONE DC

Provider Business Mailing Address
First Line	:	2445 ORO DAM BLVD E STE 1
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6035
Country	:	US
Telephone Number	:	530-533-9122
Fax Number	:	530-534-1753

Provider Business Practice Location Address
First Line	:	2445 ORO DAM BLVD E STE 1
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6035
Country	:	US
Telephone Number	:	530-533-9122
Fax Number	:	530-534-1753

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

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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