MEDICARE: DR. MARK CHARLES BAINER 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	DC24877	CA

General Provider Information

NPI Number	:	1831114024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK CHARLES BAINER D.C.

Provider Business Mailing Address
First Line	:	5006 SUNRISE BLVD STE 102
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4940
Country	:	US
Telephone Number	:	916-962-3088
Fax Number	:	916-962-3044

Provider Business Practice Location Address
First Line	:	5006 SUNRISE BLVD STE 102
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4940
Country	:	US
Telephone Number	:	916-962-3088
Fax Number	:	916-962-3044

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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