Provider Demographics
NPI:1386908879
Name:RE:HEALTH
Entity type:Organization
Organization Name:RE:HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-984-2455
Mailing Address - Street 1:3234 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6765
Mailing Address - Country:US
Mailing Address - Phone:408-984-2455
Mailing Address - Fax:408-984-2456
Practice Address - Street 1:550 WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1908
Practice Address - Country:US
Practice Address - Phone:650-757-5557
Practice Address - Fax:408-984-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18679111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty