Provider Demographics
NPI:1083643696
Name:KERENYI, VICTOR CP (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:CP
Last Name:KERENYI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:KERENYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-741-8300
Mailing Address - Fax:510-741-8338
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 175
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-741-8300
Practice Address - Fax:510-741-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0210190Medicare ID - Type Unspecified
CAU55318Medicare UPIN