Healthcare Provider Details

I. General information

NPI: 1669347134
Provider Name (Legal Business Name): JEREMIAH KLOSS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S STE 107D
HALF MOON BAY CA
94019-1738
US

IV. Provider business mailing address

424 LEE AVE
HALF MOON BAY CA
94019-1363
US

V. Phone/Fax

Practice location:
  • Phone: 541-279-3662
  • Fax:
Mailing address:
  • Phone: 541-279-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number36658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: