Provider Demographics
NPI:1992800833
Name:FALKENROTH, JOHN C (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FALKENROTH
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 1:2959 PARK AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2863
Mailing Address - Country:US
Mailing Address - Phone:831-475-8600
Mailing Address - Fax:831-475-8601
Practice Address - Street 1:2959 PARK AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2863
Practice Address - Country:US
Practice Address - Phone:831-475-8600
Practice Address - Fax:831-475-8601
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25861OtherSTATE LICENSE
CAZZZ64963AOtherBLUE SHIELD
CADC25861OtherSTATE LICENSE