Healthcare Provider Details

I. General information

NPI: 1316819030
Provider Name (Legal Business Name): REPP CALIFORNIA PAIN & RECOVERY CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

IV. Provider business mailing address

108 BARBADOS DR
PONTE VEDRA FL
32081-1506
US

V. Phone/Fax

Practice location:
  • Phone: 281-831-6290
  • Fax: 832-442-3800
Mailing address:
  • Phone: 281-831-6181
  • Fax: 832-442-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KIRT W REPP
Title or Position: PRESIDENT/CEO
Credential: DC
Phone: 281-831-6290