Healthcare Provider Details

I. General information

NPI: 1780099259
Provider Name (Legal Business Name): NICHOLAS EDWARD CRUZE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 UNION ST
SAN FRANCISCO CA
94123-4505
US

IV. Provider business mailing address

1528 UNION ST
SAN FRANCISCO CA
94123-4505
US

V. Phone/Fax

Practice location:
  • Phone: 415-236-1810
  • Fax:
Mailing address:
  • Phone: 415-236-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number32956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: