Healthcare Provider Details

I. General information

NPI: 1386817864
Provider Name (Legal Business Name): WOODSIDE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 EL CAMINO REAL
LOS ALTOS CA
94022-1330
US

IV. Provider business mailing address

4700 EL CAMINO REAL
LOS ALTOS CA
94022-1330
US

V. Phone/Fax

Practice location:
  • Phone: 650-363-1156
  • Fax:
Mailing address:
  • Phone: 650-363-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14589
License Number StateCA

VIII. Authorized Official

Name: MADELEINE SILVA
Title or Position: BILLING MANAGER
Credential:
Phone: 408-295-9970