MEDICARE: SCALCO CHIROPRACTIC A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1942057013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCALCO CHIROPRACTIC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	408 WESTMINISTER AVENUE
Second Line	:	SUITE 12
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4238
Country	:	US
Telephone Number	:	949-270-6387
Fax Number	:	949-449-8497

Provider Business Practice Location Address
First Line	:	408 WESTMINISTER AVENUE
Second Line	:	SUITE 12
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4238
Country	:	US
Telephone Number	:	949-270-6387
Fax Number	:	949-449-8497

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	RICHARD JOACHIM SCALCO JR.
Credential	:	D.C.
Telephone Number	:	949-248-4888

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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