MEDICARE: GARCIA & KAMBOURAKIS CHIROPRACTIC, INC

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	DC-28103	CA
2	225X00000X	Occupational Therapist	OT-5678	CA
3	111N00000X	Chiropractor	DC-31351	CA

General Provider Information

NPI Number	:	1881991750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARCIA & KAMBOURAKIS CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	128 AGATE AVE STE C
Second Line	:
City	:	BALBOA ISLAND
State	:	CA
Zip	:	92662-1085
Country	:	US
Telephone Number	:	949-723-0702
Fax Number	:	949-723-0026

Provider Business Practice Location Address
First Line	:	128 AGATE AVE STE C
Second Line	:
City	:	BALBOA ISLAND
State	:	CA
Zip	:	92662-1085
Country	:	US
Telephone Number	:	949-723-0702
Fax Number	:	949-723-0026

Authorized Official
Title or Position	:	PRESIDENT/CHIROPRACTOR
Name	:	DR. DANIEL THOMAS GARCIA
Credential	:	D.C.
Telephone Number	:	949-723-0702

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	03/17/2011

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