Healthcare Provider Details

I. General information

NPI: 1548465420
Provider Name (Legal Business Name): KENNETH A THOMAS CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EUREKA SQ
PACIFICA CA
94044-2652
US

IV. Provider business mailing address

320 EUREKA SQ
PACIFICA CA
94044-2652
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number21822
License Number StateCA

VIII. Authorized Official

Name: DR. KENNETH A THOMAS
Title or Position: OWNER
Credential: D.C.
Phone: 650-738-2225