MEDICARE: CHIROPRACTIC CARE CENTER INC.

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	DC-30410	CA

General Provider Information

NPI Number	:	1679713911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CARE CENTER INC.

Provider Business Mailing Address
First Line	:	112 W 9TH ST
Second Line	:	SUITE 1126
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-1510
Country	:	US
Telephone Number	:	213-627-0287
Fax Number	:	213-627-8428

Provider Business Practice Location Address
First Line	:	112 W 9TH ST
Second Line	:	SUITE 1126
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-1510
Country	:	US
Telephone Number	:	213-627-0287
Fax Number	:	213-627-8428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD C PAN
Credential	:	D.C.
Telephone Number	:	213-627-0287

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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