MEDICARE: CHIROPRACTIC & PHYSICAL THERAPY

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	225100000X	Physical Therapist	PT8264	CA

General Provider Information

NPI Number	:	1972668028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC & PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3535 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5138
Country	:	US
Telephone Number	:	562-434-0062
Fax Number	:	562-439-4617

Provider Business Practice Location Address
First Line	:	3535 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5138
Country	:	US
Telephone Number	:	562-434-0062
Fax Number	:	562-439-4617

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSE M VALENCIA
Credential	:	PT, DC
Telephone Number	:	562-434-0062

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/05/2008

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