Healthcare Provider Details

I. General information

NPI: 1578896254
Provider Name (Legal Business Name): KEARNS CHIROPRACTIC & SPORTS THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 LAFAYETTE ST STE B
SANTA CLARA CA
95050-3972
US

IV. Provider business mailing address

1543 LAFAYETTE ST STE B
SANTA CLARA CA
95050-3972
US

V. Phone/Fax

Practice location:
  • Phone: 408-244-2700
  • Fax: 408-244-2772
Mailing address:
  • Phone: 408-244-2700
  • Fax: 408-244-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number30808
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY WAYNE KEARNS
Title or Position: PRESIDENT/OWNER
Credential: DC, ATC
Phone: 408-244-2700