Healthcare Provider Details

I. General information

NPI: 1982177150
Provider Name (Legal Business Name): MEDXCARE HEALTH PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 JOSEPHINE ST STE A
SANTA CRUZ CA
95060-2775
US

IV. Provider business mailing address

149 JOSEPHINE ST STE A
SANTA CRUZ CA
95060-2775
US

V. Phone/Fax

Practice location:
  • Phone: 831-200-4217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MIKE ELLISON
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 831-200-4217