MEDICARE: GOLD COAST CHIROPRACTIC CENTER 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	DC20080	CA
2	111N00000X	Chiropractor	DC21155	CA

General Provider Information

NPI Number	:	1891894820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	120 BIRMINGHAM DR
Second Line	:	SUITE 100
City	:	CARDIFF
State	:	CA
Zip	:	92007-1757
Country	:	US
Telephone Number	:	760-944-0563
Fax Number	:	760-944-6773

Provider Business Practice Location Address
First Line	:	120 BIRMINGHAM DR
Second Line	:	SUITE 100
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-1757
Country	:	US
Telephone Number	:	760-944-0563
Fax Number	:	760-944-6773

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. LORRAINE CELESTE MELENDEZ
Credential	:	D.C.
Telephone Number	:	760-944-0563

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/23/2014

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