MEDICARE: ROCKRIDGE FAMILY 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1689964413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKRIDGE FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	6434 TELEGRAPH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1112
Country	:	US
Telephone Number	:	510-428-9288
Fax Number	:	510-428-9450

Provider Business Practice Location Address
First Line	:	6434 TELEGRAPH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1112
Country	:	US
Telephone Number	:	510-428-9288
Fax Number	:	510-428-9450

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS B ROSS
Credential	:	D.C.
Telephone Number	:	510-428-9288

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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