Healthcare Provider Details

I. General information

NPI: 1609050962
Provider Name (Legal Business Name): KIRK CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 RAY ST STE A
PLEASANTON CA
94566-6649
US

IV. Provider business mailing address

148 RAY ST STE A
PLEASANTON CA
94566-6649
US

V. Phone/Fax

Practice location:
  • Phone: 925-484-0191
  • Fax: 925-484-0194
Mailing address:
  • Phone:
  • Fax: 925-484-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC25729
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE O. KIRK IV
Title or Position: OWNER
Credential: D.C. QME
Phone: 925-484-0191