Healthcare Provider Details

I. General information

NPI: 1891115226
Provider Name (Legal Business Name): PREMIERE CORPORATE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4982 CHERRY AVE
SAN JOSE CA
95118-2748
US

IV. Provider business mailing address

4982 CHERRY AVE
SAN JOSE CA
95118-2748
US

V. Phone/Fax

Practice location:
  • Phone: 408-448-4445
  • Fax: 408-448-4447
Mailing address:
  • Phone: 408-448-4445
  • Fax: 408-448-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC30461
License Number StateCA

VIII. Authorized Official

Name: JUSTIN BRINK
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 408-448-4445