Provider Demographics
NPI:1407949118
Name:MARGARETICH, KEBBY VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:KEBBY
Middle Name:VINCENT
Last Name:MARGARETICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:KEBBY
Other - Middle Name:V
Other - Last Name:MARGARETICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:652 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7533
Mailing Address - Country:US
Mailing Address - Phone:530-273-4102
Mailing Address - Fax:530-273-6826
Practice Address - Street 1:652 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7533
Practice Address - Country:US
Practice Address - Phone:530-273-4102
Practice Address - Fax:530-273-6826
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0233090Medicare Oscar/Certification
CAU93456Medicare UPIN