Provider Demographics
NPI:1093864704
Name:KALSBEEK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KALSBEEK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALSBEEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-582-4880
Mailing Address - Street 1:21168 REDWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5932
Mailing Address - Country:US
Mailing Address - Phone:510-582-4880
Mailing Address - Fax:510-582-5408
Practice Address - Street 1:21168 REDWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5932
Practice Address - Country:US
Practice Address - Phone:510-582-4880
Practice Address - Fax:510-582-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 11753111N00000X
CADC 10567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA350020752OtherRR-BAK
CA1083707038OtherNPI
CA1BZZZ55289ZOtherBLUESHIELD
CA1053404095OtherNPI
CA350020753OtherRR-JSW
CA350020752OtherRR-BAK
CA350020753OtherRR-JSW
CA1083707038OtherNPI
CA1053404095OtherNPI