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General NPI Number Information
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NPI Number | 1154488500
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Entity Type | Organization
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Legal Business Name | DOC KIDDY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 H ST STE 1
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City | CHULA VISTA
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State | CA
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Zip | 91910-4331
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Country | US
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Telephone | 619-420-8430
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Fax | 619-420-8230
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Provider Business Mailing Address
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Address Line | 401 H ST STE 1
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City | CHULA VISTA
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State | CA
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Zip | 91910-4331
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Country | US
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Telephone | 619-420-8430
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Fax | 619-420-8230
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFERY BERNARD KIDDY
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Credential | DC
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Telephone | 619-420-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC12202
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License Number State | CA
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