MEDICARE: DR. ROBERT CHIRASAK TANTHANASIRIDEJ 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	DC30064	CA

General Provider Information

NPI Number	:	1881707578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHIRASAK TANTHANASIRIDEJ D.C.

Provider Business Mailing Address
First Line	:	4125 CLAYTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1505
Country	:	US
Telephone Number	:	323-665-0799
Fax Number	:	323-665-2784

Provider Business Practice Location Address
First Line	:	4125 CLAYTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1505
Country	:	US
Telephone Number	:	323-665-0799
Fax Number	:	323-665-2784

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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