Provider Demographics
NPI:1235152364
Name:SHASTA LAKE CHIROPRACTIC
Entity Type:Organization
Organization Name:SHASTA LAKE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-275-1585
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-0776
Mailing Address - Country:US
Mailing Address - Phone:530-275-1585
Mailing Address - Fax:530-275-8662
Practice Address - Street 1:4221 SHASTA DAM BLVD
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9423
Practice Address - Country:US
Practice Address - Phone:530-275-1585
Practice Address - Fax:530-275-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0174570OtherKAY KOBE, DC PIN
CA1912931197OtherCHRIS KOBE, DC NPI
CADC0164540OtherCHRIS KOBE, DC PIN
CAGDC000270Medicaid
CA1568496743OtherKAY KOBE, DC NPI
CADC0164540OtherCHRIS KOBE, DC PIN