Healthcare Provider Details

I. General information

NPI: 1174297188
Provider Name (Legal Business Name): CALZARETTA SPORTS CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THREE EMBARCADERO CENTER, LL5
SAN FRANCISCO CA
94111
US

IV. Provider business mailing address

PO BOX 1848
NOVATO CA
94948-1848
US

V. Phone/Fax

Practice location:
  • Phone: 415-495-2225
  • Fax: 415-495-2228
Mailing address:
  • Phone: 415-495-2225
  • Fax: 415-495-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: LISA QUINN
Title or Position: MANAGER OF ADMIN OPERATIONS
Credential:
Phone: 415-495-2225