MEDICARE: DOMINIC A CRESCI 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	11185	CA

General Provider Information

NPI Number	:	1851401095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC A CRESCI D.C.

Provider Business Mailing Address
First Line	:	700 S CLAREMONT ST STE 115
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1447
Country	:	US
Telephone Number	:	650-347-1247
Fax Number	:	650-348-7025

Provider Business Practice Location Address
First Line	:	700 S CLAREMONT ST STE 115
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1447
Country	:	US
Telephone Number	:	650-347-1247
Fax Number	:	650-348-7025

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/15/2009

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