MEDICARE: DR. GARY DOMINIC ANDREACCHI 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	DC12347	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC12347	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1780769695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DOMINIC ANDREACCHI D.C.

Provider Business Mailing Address
First Line	:	1740 MARCO POLO WAY
Second Line	:	SUITE 4
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4522
Country	:	US
Telephone Number	:	650-697-1446
Fax Number	:	650-697-1448

Provider Business Practice Location Address
First Line	:	1740 MARCO POLO WAY
Second Line	:	SUITE 4
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4522
Country	:	US
Telephone Number	:	650-697-1446
Fax Number	:	650-697-1448

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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