MEDICARE: HAYDEL & HAYDEL CHIROPRACTIC

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	DC14938	CA
2	111N00000X	Chiropractor	DC14939	CA

General Provider Information

NPI Number	:	1942522826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYDEL & HAYDEL CHIROPRACTIC

Provider Business Mailing Address
First Line	:	22344 HAWTHORNE BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-2506
Country	:	US
Telephone Number	:	310-373-0354
Fax Number	:	310-373-0356

Provider Business Practice Location Address
First Line	:	22344 HAWTHORNE BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-2506
Country	:	US
Telephone Number	:	310-373-0354
Fax Number	:	310-373-0356

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. VALERIE SPERDUTO
Credential	:
Telephone Number	:	310-373-0354

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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