Provider Demographics
NPI:1588709323
Name:DR. KENNETH FELCH CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR. KENNETH FELCH CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-948-8900
Mailing Address - Street 1:644 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-4812
Mailing Address - Country:US
Mailing Address - Phone:650-948-8900
Mailing Address - Fax:650-948-8827
Practice Address - Street 1:644 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-4812
Practice Address - Country:US
Practice Address - Phone:650-948-8900
Practice Address - Fax:650-948-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZZ06912ZOtherPTAN
CAU95992Medicare UPIN