Healthcare Provider Details

I. General information

NPI: 1831497965
Provider Name (Legal Business Name): SINO-LEGACY ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46164 WARM SPRINGS BLVD UNIT 266
FREMONT CA
94539-7985
US

IV. Provider business mailing address

46164 WARM SPRINGS BLVD UNIT 266
FREMONT CA
94539-7985
US

V. Phone/Fax

Practice location:
  • Phone: 510-623-8787
  • Fax: 510-623-8788
Mailing address:
  • Phone: 510-623-8787
  • Fax: 510-623-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27826
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0278260
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC18679
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC0066920
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6692
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13796
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2765
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11584
License Number StateCA

VIII. Authorized Official

Name: MR. DAMON CHARLES FRACH
Title or Position: OWNER DIRECTOR
Credential: PHD
Phone: 408-984-2455