Provider Demographics
NPI:1437482353
Name:LELKE, JOHANNA MAE (DC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MAE
Last Name:LELKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 ADDISON ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702
Mailing Address - Country:US
Mailing Address - Phone:510-883-1126
Mailing Address - Fax:510-883-9926
Practice Address - Street 1:1250 ADDISON ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702
Practice Address - Country:US
Practice Address - Phone:510-883-1126
Practice Address - Fax:510-883-9926
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31356111N00000X
COCHR-6375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor