Provider Demographics
NPI:1154488500
Name:DOC KIDDY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:DOC KIDDY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-420-8430
Mailing Address - Street 1:401 H ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4331
Mailing Address - Country:US
Mailing Address - Phone:619-420-8430
Mailing Address - Fax:619-420-8230
Practice Address - Street 1:401 H ST STE 1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4331
Practice Address - Country:US
Practice Address - Phone:619-420-8430
Practice Address - Fax:619-420-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty