MEDICARE: HEALTH CONNECTION CHIROPRACTIC

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	305R00000X	Preferred Provider Organization	DC31789	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1235424078	OTHER	CA	NPI

General Provider Information

NPI Number	:	1609297878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CONNECTION CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2801 MOORPARK AVE SUITE 2
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128
Country	:	US
Telephone Number	:	408-624-7543
Fax Number	:	408-261-1915

Provider Business Practice Location Address
First Line	:	2801 MOORPARK AVE STE 2
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3103
Country	:	US
Telephone Number	:	408-624-7543
Fax Number	:	408-261-1915

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MARY CHAN
Credential	:	DC
Telephone Number	:	408-624-7543

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/13/2013

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Directions to “HEALTH CONNECTION CHIROPRACTIC ” Practice Location

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