MEDICARE: COLLEGE HEALTH CENTER

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	111NS0005X	Sports Physician Chiropractor	31965	CA
2	111N00000X	Chiropractor	31479	CA

General Provider Information

NPI Number	:	1851659197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEGE HEALTH CENTER

Provider Business Mailing Address
First Line	:	4560 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4012
Country	:	US
Telephone Number	:	619-948-5323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4012
Country	:	US
Telephone Number	:	619-948-5323
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. DANNY B BACHOUA
Credential	:	DC
Telephone Number	:	619-948-5323

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	04/24/2012

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Directions to “COLLEGE HEALTH CENTER ” Practice Location

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