Healthcare Provider Details

I. General information

NPI: 1609297878
Provider Name (Legal Business Name): HEALTH CONNECTION CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MOORPARK AVE STE 2
SAN JOSE CA
95128-3103
US

IV. Provider business mailing address

2801 MOORPARK AVE SUITE 2
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-624-7543
  • Fax: 408-261-1915
Mailing address:
  • Phone: 408-624-7543
  • Fax: 408-261-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDC31789
License Number StateCA

VIII. Authorized Official

Name: MARY CHAN
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 408-624-7543