MEDICARE: NAZARETH CLINIC CORP

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	DC25845	CA
2	171100000X	Acupuncturist	AC 6463	CA
3	111NS0005X	Sports Physician Chiropractor	DC 25845	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC 25845	OTHER	CA	CALIFORNIA BOARD OF CHIROPRACTIC EXAMINERS
2	AC 6463	OTHER	CA	CALIFORNIA ACUPUNCTURE BOARD

General Provider Information

NPI Number	:	1598923716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZARETH CLINIC CORP

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD STE 321
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2279
Country	:	US
Telephone Number	:	213-389-5865
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD STE 321
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2279
Country	:	US
Telephone Number	:	213-389-5865
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LEE CHOU
Credential	:	DC
Telephone Number	:	213-389-5865

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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Directions to “NAZARETH CLINIC CORP ” Practice Location

Language	Start Address	Practice Location

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