Healthcare Provider Details

I. General information

NPI: 1982385415
Provider Name (Legal Business Name): CORELITE CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S BASCOM AVE STE 103
CAMPBELL CA
95008-3269
US

IV. Provider business mailing address

2020 S BASCOM AVE STE 103
CAMPBELL CA
95008-3269
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-8820
  • Fax:
Mailing address:
  • Phone: 408-866-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: HILARY GROSS
Title or Position: OWNER
Credential:
Phone: 408-866-8820