MEDICARE: JUDE JIX CORTES 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	DC-28938	CA

General Provider Information

NPI Number	:	1629070081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDE JIX CORTES D.C.

Provider Business Mailing Address
First Line	:	7441 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6004
Country	:	US
Telephone Number	:	619-464-1600
Fax Number	:	619-464-6546

Provider Business Practice Location Address
First Line	:	7441 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6004
Country	:	US
Telephone Number	:	619-464-1600
Fax Number	:	619-464-6546

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/24/2009

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