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General NPI Number Information
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NPI Number | 1861533069
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS CLINIC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 615 S MAIN ST SUITE 1
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City | MILPITAS
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State | CA
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Zip | 95035-8521
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Country | US
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Telephone | 408-945-7717
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Fax | 408-946-8145
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Provider Business Mailing Address
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Address Line | 615 S MAIN ST SUITE 1
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City | MILPITAS
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State | CA
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Zip | 95035-8521
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Country | US
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Telephone | 408-945-7717
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Fax | 408-946-8145
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA J KIM
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Credential | D.C.
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Telephone | 408-945-7717
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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 |
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License Number State |
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