Provider Demographics
NPI:1043364185
Name:QUACH, KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S DE ANZA BLVD
Mailing Address - Street 2:STE 5
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2772
Mailing Address - Country:US
Mailing Address - Phone:408-873-7610
Mailing Address - Fax:408-873-7135
Practice Address - Street 1:1035 S DE ANZA BLVD
Practice Address - Street 2:STE 5
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2772
Practice Address - Country:US
Practice Address - Phone:408-873-7610
Practice Address - Fax:408-873-7135
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0275180Medicare ID - Type Unspecified