Healthcare Provider Details

I. General information

NPI: 1558376251
Provider Name (Legal Business Name): ANDREW H KOHLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 F ST
CHULA VISTA CA
91910-2818
US

IV. Provider business mailing address

PO BOX 1176
CARDIFF CA
92007-7176
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-7858
  • Fax: 619-420-4569
Mailing address:
  • Phone: 858-509-7999
  • Fax: 858-509-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number18242
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC18242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: