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General NPI Number Information
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NPI Number | 1356714752
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR CORRECTIVE EXERCISE
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 3975 5TH AVE SUITE 213
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City | SAN DIEGO
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State | CA
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Zip | 92103-3101
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Country | US
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Telephone | 619-906-7055
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Fax | 619-639-8269
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Provider Business Mailing Address
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Address Line | 113 W G ST # 819
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City | SAN DIEGO
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State | CA
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Zip | 92101-6096
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Country | US
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Telephone | 619-906-7055
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Fax | 619-639-8269
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH ANDREW CLARKE
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Credential | CMT
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Telephone | 858-522-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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