Healthcare Provider Details

I. General information

NPI: 1942427588
Provider Name (Legal Business Name): ANDRE MATHIEU CHEVALIER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 EL CAMINO REAL SUITE 100
SANTA CLARA CA
95050-4257
US

IV. Provider business mailing address

1265 EL CAMINO REAL SUITE 100
SANTA CLARA CA
95050-4257
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-8326
  • Fax: 408-241-2600
Mailing address:
  • Phone: 408-241-8326
  • Fax: 408-241-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21269
License Number StateCA

VIII. Authorized Official

Name: DR. ANDRE MATHIEU CHEVALIER
Title or Position: OWNER
Credential: D.C.
Phone: 408-241-8326