Healthcare Provider Details

I. General information

NPI: 1558281279
Provider Name (Legal Business Name): JOSE A ACEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 RUFF CT
PINOLE CA
94564-1432
US

IV. Provider business mailing address

2764 RUFF CT
PINOLE CA
94564-1432
US

V. Phone/Fax

Practice location:
  • Phone: 510-691-8211
  • Fax:
Mailing address:
  • Phone: 510-691-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: