Provider Demographics
NPI:1376675660
Name:EICHHORST, KEVIN R (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:EICHHORST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CALAVERAS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7708
Mailing Address - Country:US
Mailing Address - Phone:408-262-6620
Mailing Address - Fax:
Practice Address - Street 1:500 E CALAVERAS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7708
Practice Address - Country:US
Practice Address - Phone:408-262-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75829Medicare UPIN
CADC0260450Medicare ID - Type Unspecified