MEDICARE: RENEE M. DAVIDSON, DC A 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	DC13996	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0139960	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1952526238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEE M. DAVIDSON, DC A 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	:	2107 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2003
Country	:	US
Telephone Number	:	323-664-6003
Fax Number	:	323-664-8931

Authorized Official
Title or Position	:	PROVIDER OWNER
Name	:	RENEE M DAVIDSON
Credential	:	D.C.
Telephone Number	:	323-664-6003

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	10/18/2007

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