MEDICARE: DR. JAMES THOMAS IWANOFF 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	DC13558	CA

General Provider Information

NPI Number	:	1821101148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THOMAS IWANOFF D.C.

Provider Business Mailing Address
First Line	:	30423 CANWOOD ST
Second Line	:	SUITE 225
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2082
Country	:	US
Telephone Number	:	818-707-2225
Fax Number	:	818-991-9070

Provider Business Practice Location Address
First Line	:	30423 CANWOOD ST
Second Line	:	SUITE 225
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2082
Country	:	US
Telephone Number	:	818-797-2225
Fax Number	:	818-991-9070

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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