Healthcare Provider Details

I. General information

NPI: 1902082902
Provider Name (Legal Business Name): CHARONIS CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 LAUREL ST SUITE A
SAN CARLOS CA
94070-5217
US

IV. Provider business mailing address

1682 LAUREL ST SUITE A
SAN CARLOS CA
94070-5217
US

V. Phone/Fax

Practice location:
  • Phone: 650-631-1500
  • Fax: 650-631-1504
Mailing address:
  • Phone: 650-631-1500
  • Fax: 650-631-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27902
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91713
License Number StateCA

VIII. Authorized Official

Name: ANGELO CHARONIS
Title or Position: PRESIDENT
Credential: DC
Phone: 650-631-1500