Healthcare Provider Details

I. General information

NPI: 1528414778
Provider Name (Legal Business Name): CHIRO-MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4003
US

IV. Provider business mailing address

PO BOX 1848
NOVATO CA
94948-1848
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: LISA QUINN
Title or Position: MANAGER OF ADMINISTRATIVE OPERATION
Credential:
Phone: 415-892-7560