MEDICARE: GATEWAY CHIROPRACTIC GROUP

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

General Provider Information

NPI Number	:	1639404023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY CHIROPRACTIC GROUP

Provider Business Mailing Address
First Line	:	2677 ZOE AVE
Second Line	:	SUITE 305
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4195
Country	:	US
Telephone Number	:	323-583-0014
Fax Number	:	323-583-8843

Provider Business Practice Location Address
First Line	:	2677 ZOE AVE
Second Line	:	SUITE 305
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4195
Country	:	US
Telephone Number	:	323-583-0014
Fax Number	:	323-583-8843

Authorized Official
Title or Position	:	PARTNER
Name	:	HOMAYOUN DAVID HAMIDI
Credential	:	D.C.
Telephone Number	:	714-863-6196

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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