Healthcare Provider Details

I. General information

NPI: 1356714752
Provider Name (Legal Business Name): THE CENTER FOR CORRECTIVE EXERCISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 5TH AVE SUITE 213
SAN DIEGO CA
92103-3101
US

IV. Provider business mailing address

113 W G ST # 819
SAN DIEGO CA
92101-6096
US

V. Phone/Fax

Practice location:
  • Phone: 619-906-7055
  • Fax: 619-639-8269
Mailing address:
  • Phone: 619-906-7055
  • Fax: 619-639-8269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH ANDREW CLARKE
Title or Position: OWNER
Credential: CMT
Phone: 858-522-0526