Healthcare Provider Details

I. General information

NPI: 1396775094
Provider Name (Legal Business Name): PAUL J. LIENHART DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 SOUTH BASCOM AVE. SUITE 212
SAN JOSE CA
95128-3512
US

IV. Provider business mailing address

1190 SOUTH BASCOM AVE. SUITE 212
SAN JOSE CA
95128-3512
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-1999
  • Fax: 408-885-9595
Mailing address:
  • Phone: 408-885-1999
  • Fax: 408-885-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number016-469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: