Healthcare Provider Details

I. General information

NPI: 1710828512
Provider Name (Legal Business Name): KBH ELITE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1772 E AVENIDA DE LOS ARBOLES STE R
THOUSAND OAKS CA
91362-6116
US

IV. Provider business mailing address

1772 E AVENIDA DE LOS ARBOLES STE R STE R
THOUSAND OAKS CA
91362-6116
US

V. Phone/Fax

Practice location:
  • Phone: 718-825-5102
  • Fax:
Mailing address:
  • Phone: 718-825-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLLY COOPER
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 714-401-0877