MEDICARE: DR. MARY JO GIAGIARI-CLARKE 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	DC018416	CA

General Provider Information

NPI Number	:	1598836389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO GIAGIARI-CLARKE DC

Provider Business Mailing Address
First Line	:	644 FREMONT AVE
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4812
Country	:	US
Telephone Number	:	650-948-2238
Fax Number	:	650-948-2363

Provider Business Practice Location Address
First Line	:	644 FREMONT AVE
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4812
Country	:	US
Telephone Number	:	650-948-2238
Fax Number	:	650-948-2363

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/08/2011

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