Healthcare Provider Details

I. General information

NPI: 1427361435
Provider Name (Legal Business Name): KELLY SHAWN MAGUIRE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 CALIFORNIA DR SUITE 100
MILLBRAE CA
94030-3125
US

IV. Provider business mailing address

199 CALIFORNIA DR SUITE 100
MILLBRAE CA
94030-3125
US

V. Phone/Fax

Practice location:
  • Phone: 650-692-2273
  • Fax: 650-692-6237
Mailing address:
  • Phone: 650-692-2273
  • Fax: 650-692-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31599
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1156
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: