Healthcare Provider Details

I. General information

NPI: 1477507556
Provider Name (Legal Business Name): SANCHEZ CHIROPRACTIC WELLNESS CENTER PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 SAMARITAN DR SUITE J
SAN JOSE CA
95124-4108
US

IV. Provider business mailing address

2516 SAMARITAN DR SUITE J
SAN JOSE CA
95124-4108
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-2061
  • Fax: 408-356-2071
Mailing address:
  • Phone: 408-356-2061
  • Fax: 408-356-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 29588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2966
License Number StateCA

VIII. Authorized Official

Name: DR. FREDY FERNANDO SANCHEZ
Title or Position: C.E.O
Credential: D.C., P.T
Phone: 408-356-2061