Healthcare Provider Details

I. General information

NPI: 1427535525
Provider Name (Legal Business Name): MARIANNE NIELSEN CHIROPRACTIC NEUROLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 LOS GATOS SARATOGA RD
LOS GATOS CA
95030-5310
US

IV. Provider business mailing address

321 LOS GATOS SARATOGA RD
LOS GATOS CA
95030-5310
US

V. Phone/Fax

Practice location:
  • Phone: 408-395-6995
  • Fax:
Mailing address:
  • Phone: 408-395-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCA22103
License Number StateCA

VIII. Authorized Official

Name: MARIANNE NIELSEN
Title or Position: PRESIDENT
Credential: DC
Phone: 408-395-6995