=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306969712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUN CENTER FOR WELL BEING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE MIRADA ROAD
-----------------------------------------------------
City | HALF MOON BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-726-9786
-----------------------------------------------------
Fax | 650-726-9786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE MIRADA ROAD
-----------------------------------------------------
City | HALF MOON BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-726-9786
-----------------------------------------------------
Fax | 650-726-9786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DUSTIN R CRAFT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 650-726-9786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 28891
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 27978
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------