MEDICARE: MS. CHERI SUE JOSEPH L.AC.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	AC5486	CA

General Provider Information

NPI Number	:	1801968292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERI SUE JOSEPH L.AC.

Provider Business Mailing Address
First Line	:	1780 KETTNER BLVD
Second Line	:	110
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2552
Country	:	US
Telephone Number	:	619-808-8314
Fax Number	:	619-795-0846

Provider Business Practice Location Address
First Line	:	2180 GARNET AVE
Second Line	:	1-I
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3610
Country	:	US
Telephone Number	:	619-808-8314
Fax Number	:	619-795-0846

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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