Healthcare Provider Details

I. General information

NPI: 1588723431
Provider Name (Legal Business Name): STANFORD MULTIDISCIPLINARY SPINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43575 MISSION BLVD # 707
FREMONT CA
94539-5831
US

IV. Provider business mailing address

43575 MISSION BLVD # 707
FREMONT CA
94539-5831
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-6366
  • Fax: 510-657-3849
Mailing address:
  • Phone: 510-657-6366
  • Fax: 510-657-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberG639560
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD KARL SKALA
Title or Position: COO
Credential: DC
Phone: 510-657-6366