MEDICARE: GIAQUINTO CENTER FOR DIGESTIVE AND CHIROPRACTIC HEALTH 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	111NN1001X	Nutrition Chiropractor	DC 28952	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1225115025	OTHER	CA	PERSONAL NPI

General Provider Information

NPI Number	:	1821126681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIAQUINTO CENTER FOR DIGESTIVE AND CHIROPRACTIC HEALTH INC.

Provider Business Mailing Address
First Line	:	2634 WILSHIRE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2634 WILSHIRE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4623
Country	:	US
Telephone Number	:	310-315-1828
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH GIAQUINTO
Credential	:
Telephone Number	:	310-315-1828

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	05/12/2010

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