Healthcare Provider Details

I. General information

NPI: 1023057866
Provider Name (Legal Business Name): AUDREY J EGAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 FILLMORE ST STE. 100
SAN FRANCISCO CA
94115-3180
US

IV. Provider business mailing address

1505 PERSHING DR APT D
SAN FRANCISCO CA
94129-1078
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-9995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: