MEDICARE: MS. KERRIE PRATT 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	23353	CA
2	111NI0013X	Independent Medical Examiner Chiropractor	23353	CA

General Provider Information

NPI Number	:	1609128529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRIE PRATT D.C.

Provider Business Mailing Address
First Line	:	PO BOX 90570
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90009-0570
Country	:	US
Telephone Number	:	323-724-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 S ATLANTIC BLVD
Second Line	:	SUITE 107
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1754
Country	:	US
Telephone Number	:	323-724-1866
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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