Provider Demographics
NPI:1669347134
Name:KLOSS, JEREMIAH (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:KLOSS
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 1:424 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1363
Mailing Address - Country:US
Mailing Address - Phone:541-279-3662
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S STE 107D
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1738
Practice Address - Country:US
Practice Address - Phone:541-279-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 226300000X
CA36658111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist