Provider Demographics
NPI:1467519488
Name:KENT G CARLOMAGNO A PROF CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:KENT G CARLOMAGNO A PROF CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CARLOMAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-721-7520
Mailing Address - Street 1:710 C ST
Mailing Address - Street 2:STE 12
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3857
Mailing Address - Country:US
Mailing Address - Phone:415-721-7520
Mailing Address - Fax:416-721-7535
Practice Address - Street 1:710 C ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3857
Practice Address - Country:US
Practice Address - Phone:415-721-7520
Practice Address - Fax:416-721-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-01-05
Deactivation Date:2008-08-05
Deactivation Code:
Reactivation Date:2011-01-05
Provider Licenses
StateLicense IDTaxonomies
CA15882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467519488OtherNPI
CADC0158820Medicare PIN
CA1467519488OtherNPI