MEDICARE: STONE BECK TOWER 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	24084	CA

General Provider Information

NPI Number	:	1902171523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE BECK TOWER CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1405 E OLIVE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-3619
Country	:	US
Telephone Number	:	559-459-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 E OLIVE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-3619
Country	:	US
Telephone Number	:	559-459-0224
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STONE BECK
Credential	:	DC
Telephone Number	:	559-459-0224

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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