Provider Demographics
NPI:1720149487
Name:MODENBACH, WILLIAM KEITH (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEITH
Last Name:MODENBACH
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 1:1738 STANLEY DOLLAR DRIVE
Mailing Address - Street 2:#2B
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595
Mailing Address - Country:US
Mailing Address - Phone:925-935-9700
Mailing Address - Fax:925-935-9914
Practice Address - Street 1:43 QUAIL COURT
Practice Address - Street 2:#202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-944-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor