MEDICARE: OLGA TABAROVSKAYA 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	DC30275	CA

General Provider Information

NPI Number	:	1710091152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA TABAROVSKAYA D.C.

Provider Business Mailing Address
First Line	:	8205 SANTA MONICA BLVD
Second Line	:	SUITE 12-B
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5977
Country	:	US
Telephone Number	:	323-819-5099
Fax Number	:	323-656-5115

Provider Business Practice Location Address
First Line	:	8205 SANTA MONICA BLVD
Second Line	:	SUITE 12-B
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5977
Country	:	US
Telephone Number	:	323-819-5099
Fax Number	:	323-656-5115

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	09/12/2013

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