MEDICARE: BORGES CHIROPRACTIC A PC

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	17019	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350025349	OTHER	CA	RAILROAD PROVIDER #

General Provider Information

NPI Number	:	1881789055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORGES CHIROPRACTIC A PC

Provider Business Mailing Address
First Line	:	2074 LAKE TAHOE BLVD STE 5
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6408
Country	:	US
Telephone Number	:	530-544-5800
Fax Number	:	530-544-5802

Provider Business Practice Location Address
First Line	:	2074 LAKE TAHOE BLVD STE 5
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6408
Country	:	US
Telephone Number	:	530-544-5800
Fax Number	:	530-544-5802

Authorized Official
Title or Position	:	VP
Name	:	KAREN BORGES
Credential	:	DC
Telephone Number	:	530-544-5800

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/03/2024

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