Healthcare Provider Details

I. General information

NPI: 1124434519
Provider Name (Legal Business Name): LOPEZ PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 11TH ST
SAN JOSE CA
95112-2217
US

IV. Provider business mailing address

300 S 11TH ST
SAN JOSE CA
95112-2217
US

V. Phone/Fax

Practice location:
  • Phone: 408-600-1188
  • Fax: 408-280-7844
Mailing address:
  • Phone: 408-600-1188
  • Fax: 408-280-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31529
License Number StateCA

VIII. Authorized Official

Name: DR. ANGELA LOPEZ
Title or Position: PRESIDENT/ CO-OWNER
Credential: DC
Phone: 408-642-0344