MEDICARE: CASTROVILLE CHIROPRACTIC CLINIC

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	261Q00000X	Clinic/Center	14412	CA

General Provider Information

NPI Number	:	1902232606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTROVILLE CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	11282 MERRITT ST
Second Line	:
City	:	CASTROVILLE
State	:	CA
Zip	:	95012-3421
Country	:	US
Telephone Number	:	831-633-4067
Fax Number	:	831-633-4070

Provider Business Practice Location Address
First Line	:	11282 MERRITT ST
Second Line	:
City	:	CASTROVILLE
State	:	CA
Zip	:	95012-3421
Country	:	US
Telephone Number	:	831-633-4067
Fax Number	:	831-633-4070

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. RANDAL GREGORY JONES
Credential	:	D.C.
Telephone Number	:	831-633-4067

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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