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General NPI Number Information
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NPI Number | 1386908879
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Entity Type | Organization
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Legal Business Name | RE:HEALTH
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 550 WASHINGTON ST STE 101
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City | DALY CITY
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State | CA
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Zip | 94015-1908
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Country | US
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Telephone | 650-757-5557
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Fax | 408-984-2456
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Provider Business Mailing Address
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Address Line | 3234 MCKINLEY DR
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City | SANTA CLARA
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State | CA
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Zip | 95051-6765
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Country | US
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Telephone | 408-984-2455
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Fax | 408-984-2456
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | DR. CHARLES D FRACH
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Credential | PHD
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Telephone | 408-984-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC18679
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License Number State | CA
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