Healthcare Provider Details

I. General information

NPI: 1659739811
Provider Name (Legal Business Name): CHEVALIER SPORTS CHIROPRACTIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 EL CAMINO REAL SUITE 180
SANTA CLARA CA
95050-4257
US

IV. Provider business mailing address

1265 EL CAMINO REAL SUITE 180
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 TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13931
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number21269
License Number StateCA

VIII. Authorized Official

Name: DR. ANDRE MATHIEU CHEVALIER
Title or Position: CEO
Credential: D.C., D.A.C.B.S.P.
Phone: 408-241-8326