Healthcare Provider Details

I. General information

NPI: 1710295621
Provider Name (Legal Business Name): KENT KARRAS CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RAY ST
SAN DIEGO CA
92104-3623
US

IV. Provider business mailing address

3800 RAY ST
SAN DIEGO CA
92104-3623
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-9205
  • Fax: 619-294-9860
Mailing address:
  • Phone: 619-294-9205
  • Fax: 619-294-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC26561
License Number StateCA

VIII. Authorized Official

Name: DR. KENT EDWARD KARRAS
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 619-294-9205