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General NPI Number Information
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NPI Number | 1861907198
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Entity Type | Organization
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Legal Business Name | POSITIVE MOTION CHIROPRACTIC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 15951 LOS GATOS BLVD STE 3
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City | LOS GATOS
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State | CA
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Zip | 95032-3428
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Country | US
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Telephone | 408-358-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 15951 LOS GATOS BLVD STE 3
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City | LOS GATOS
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State | CA
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Zip | 95032-3428
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Country | US
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Telephone | 408-358-5086
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANT PEDERSEN
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Credential | DC
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Telephone | 408-358-5086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC-33022
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC-29419
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License Number State | CA
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