Provider Demographics
NPI:1427066315
Name:CRUZ, DAVID PAUL (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 REDWOOD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4110
Mailing Address - Country:US
Mailing Address - Phone:415-895-5636
Mailing Address - Fax:415-895-5634
Practice Address - Street 1:7100 REDWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-895-5636
Practice Address - Fax:415-895-5634
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0247771Medicare ID - Type Unspecified