Healthcare Provider Details

I. General information

NPI: 1992800833
Provider Name (Legal Business Name): JOHN C FALKENROTH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 PARK AVE SUITE F
SOQUEL CA
95073-2863
US

IV. Provider business mailing address

2959 PARK AVE STE F
SOQUEL CA
95073-2863
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-8600
  • Fax: 831-475-8601
Mailing address:
  • Phone: 831-475-8600
  • Fax: 831-475-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: