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General NPI Number Information
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NPI Number | 1912213539
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Entity Type | Organization
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Legal Business Name | PLATON KAVVADIAS, A PROFESSIONAL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 654 JENEVEIN AVE
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City | SAN BRUNO
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State | CA
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Zip | 94066-4230
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Country | US
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Telephone | 650-877-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 654 JENEVEIN AVE
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City | SAN BRUNO
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State | CA
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Zip | 94066-4230
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Country | US
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Telephone | 650-877-0999
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | MR. PLATON KAVVADIAS
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Credential | DC
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Telephone | 650-877-0999
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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 | DC24438
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License Number State | CA
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