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General NPI Number Information
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NPI Number | 1285038653
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Entity Type | Organization
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Legal Business Name | KINETIC CHIROPRACTIC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 3156 SPORTS ARENA BOULEVARD SUITE 106
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City | SAN DIEGO
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State | CA
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Zip | 92110
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Country | US
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Telephone | 818-687-0867
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Fax |
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Provider Business Mailing Address
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Address Line | 3156 SPORTS ARENA BLVD STE 106
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City | SAN DIEGO
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State | CA
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Zip | 92110-4504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JUSTIN THOMAS PAQUETTE
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Credential | D.C.
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Telephone | 818-687-0867
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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 | 33084
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License Number State | CA
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