MEDICARE: DR. DEVI S. NAMBUDRIPAD D.C., L.AC., PH.D.

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	111NN1001X	Nutrition Chiropractor	16776	CA

General Provider Information

NPI Number	:	1992983928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVI S. NAMBUDRIPAD D.C., L.AC., PH.D.

Provider Business Mailing Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-523-8900
Fax Number	:	714-523-3068

Provider Business Practice Location Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-523-8900
Fax Number	:	714-523-3068

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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