Provider Demographics
NPI:1588710966
Name:GIRLANDO, JOHN BEN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BEN
Last Name:GIRLANDO
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 1:2305 VAN NESS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-1899
Mailing Address - Country:US
Mailing Address - Phone:415-775-7500
Mailing Address - Fax:
Practice Address - Street 1:2305 VAN NESS AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-1899
Practice Address - Country:US
Practice Address - Phone:415-775-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 22684Medicare ID - Type Unspecified