Healthcare Provider Details

I. General information

NPI: 1912931197
Provider Name (Legal Business Name): CHRISTOPHER LEWIS KOBE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 SHASTA DAM BLVD
SHASTA LAKE CA
96019-9423
US

IV. Provider business mailing address

PO BOX 776
SHASTA LAKE CA
96019-0776
US

V. Phone/Fax

Practice location:
  • Phone: 530-275-1585
  • Fax: 530-275-8662
Mailing address:
  • Phone: 530-275-1585
  • Fax: 530-275-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: