Provider Demographics
NPI:1710994678
Name:BASCO, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BASCO
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2236 MARINER SQUARE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1071
Mailing Address - Country:US
Mailing Address - Phone:510-523-6773
Mailing Address - Fax:510-523-6772
Practice Address - Street 1:2236 MARINER SQUARE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1071
Practice Address - Country:US
Practice Address - Phone:510-523-6773
Practice Address - Fax:510-523-6772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC25650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03192Medicare UPIN