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General NPI Number Information
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NPI Number | 1609050962
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Entity Type | Organization
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Legal Business Name | KIRK CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 148 RAY ST STE A
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City | PLEASANTON
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State | CA
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Zip | 94566-6649
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Country | US
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Telephone | 925-484-0191
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Fax | 925-484-0194
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Provider Business Mailing Address
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Address Line | 148 RAY ST STE A
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City | PLEASANTON
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State | CA
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Zip | 94566-6649
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Country | US
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Telephone |
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Fax | 925-484-0194
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE O. KIRK IV
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Credential | D.C. QME
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Telephone | 925-484-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | DC25729
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License Number State | CA
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