Healthcare Provider Details

I. General information

NPI: 1093042244
Provider Name (Legal Business Name): BRAD PLUCKHAN, D.C. A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 SANTA TERESA BLVD SUITE 110
GILROY CA
95020-3867
US

IV. Provider business mailing address

8060 SANTA TERESA BLVD SUITE 110
GILROY CA
95020-3867
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-2225
  • Fax: 408-842-6700
Mailing address:
  • Phone: 408-848-2225
  • Fax: 408-842-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC250920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23508
License Number StateCA

VIII. Authorized Official

Name: DR. BRAD J PLUCKHAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 408-848-2225