Healthcare Provider Details

I. General information

NPI: 1750491163
Provider Name (Legal Business Name): CHIRO MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 1ST ST SUITE 101
SAN FRANCISCO CA
94105-2636
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: 415-897-9195
  • Fax: 415-897-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN WHEATON
Title or Position: MANAGER
Credential:
Phone: 415-897-9195