Healthcare Provider Details

I. General information

NPI: 1134480932
Provider Name (Legal Business Name): IN HEALTH CLINIC, LY HO CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 LOS GATOS BLVD STE 1
LOS GATOS CA
95032-2028
US

IV. Provider business mailing address

15100 LOS GATOS BLVD STE 1
LOS GATOS CA
95032-2028
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-0270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number31073
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number31086
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31073
License Number StateCA

VIII. Authorized Official

Name: DR. LY HO
Title or Position: CEO
Credential:
Phone: 408-356-0270