Provider Demographics
NPI:1003112004
Name:KEITH M. HOURIHAN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KEITH M. HOURIHAN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOURIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-558-0057
Mailing Address - Street 1:6755 MIRA MESA BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4392
Mailing Address - Country:US
Mailing Address - Phone:858-558-0057
Mailing Address - Fax:
Practice Address - Street 1:6755 MIRA MESA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4392
Practice Address - Country:US
Practice Address - Phone:858-558-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty