Provider Demographics
NPI:1568496743
Name:KOBE, KAY ELLEN (DC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:ELLEN
Last Name:KOBE
Suffix:
Gender:F
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:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-0776
Mailing Address - Country:US
Mailing Address - Phone:530-275-1585
Mailing Address - Fax:530-275-8662
Practice Address - Street 1:4221 SHASTA DAM BLVD
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9423
Practice Address - Country:US
Practice Address - Phone:530-275-1585
Practice Address - Fax:530-275-8662
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235152364OtherGROUP NPI
CADC0174570Medicaid
1912931197OtherPARTNERCHRIS KOBE, DC NPI
CAZZZ08124ZOtherBLUE SHIELD/CROSS GROUP
CAZZZ27906ZOtherGROUP MEDICARE
1912931197OtherPARTNERCHRIS KOBE, DC NPI
CA1235152364OtherGROUP NPI