Healthcare Provider Details

I. General information

NPI: 1104736925
Provider Name (Legal Business Name): IDO BARUCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5259 PROSPECT RD
SAN JOSE CA
95129-5025
US

IV. Provider business mailing address

1125 HOLLOWAY AVE
SAN FRANCISCO CA
94132-2727
US

V. Phone/Fax

Practice location:
  • Phone: 408-763-8942
  • Fax:
Mailing address:
  • Phone: 415-987-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: