MEDICARE: DAVE R. MULL A PROFESSIONAL CHIROPRACTIC CORP

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	DC16011	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0160110	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1942381694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVE R. MULL A PROFESSIONAL CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	2221 PALO VERDE AVE # 1J-K
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2364
Country	:	US
Telephone Number	:	562-795-7007
Fax Number	:	562-795-7009

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DAVE MULL
Credential	:	D.C.
Telephone Number	:	562-795-7007

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/17/2007

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