MEDICARE: DANA LARIDAEN CHIROPRACTIC 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	111N00000X	Chiropractor	DC-30839	CA

General Provider Information

NPI Number	:	1699031393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANA LARIDAEN CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	2817 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	310-392-3929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	310-392-3929
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. DANA J LARIDAEN
Credential	:	D.C.
Telephone Number	:	310-392-3929

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	04/06/2012

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