MEDICARE: CHIRO MEDICAL GROUP, 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		CA

General Provider Information

NPI Number	:	1750491163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94948-1848
Country	:	US
Telephone Number	:	415-897-9195
Fax Number	:	415-897-0346

Provider Business Practice Location Address
First Line	:	246 1ST ST
Second Line	:	SUITE 101
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-2636
Country	:	US
Telephone Number	:	415-495-2225
Fax Number	:	415-495-2228

Authorized Official
Title or Position	:	MANAGER
Name	:	LAUREN WHEATON
Credential	:
Telephone Number	:	415-897-9195

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/21/2022

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Directions to “CHIRO MEDICAL GROUP, INC ” Practice Location

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