Healthcare Provider Details

I. General information

NPI: 1295810364
Provider Name (Legal Business Name): KELLY CHAU CAO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY CHAU LE D.C.

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9039 BOLSA AVE SUITE 114
WESTMINSTER CA
92683-5572
US

IV. Provider business mailing address

9039 BOLSA AVE SUITE 114
WESTMINSTER CA
92683-5572
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-2255
  • Fax: 714-899-2215
Mailing address:
  • Phone: 714-899-2255
  • Fax: 714-899-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: