MEDICARE: DR. FERDINAND MORALES LOPEZ DC

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	25077	CA

General Provider Information

NPI Number	:	1972755924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERDINAND MORALES LOPEZ DC

Provider Business Mailing Address
First Line	:	2545 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-391-6512
Fax Number	:	909-391-2653

Provider Business Practice Location Address
First Line	:	2545 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-391-6512
Fax Number	:	909-391-2653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	12/21/2010

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