Provider Demographics
NPI:1477507556
Name:SANCHEZ CHIROPRACTIC WELLNESS CENTER PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SANCHEZ CHIROPRACTIC WELLNESS CENTER PAIN MANAGEMENT
Other - Org Name:STAR WELLNESS CENTER/SANCHEZ STAR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDY
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:408-356-2061
Mailing Address - Street 1:2516 SAMARITAN DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4108
Mailing Address - Country:US
Mailing Address - Phone:408-356-2061
Mailing Address - Fax:408-356-2071
Practice Address - Street 1:2516 SAMARITAN DR
Practice Address - Street 2:SUITE J
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4108
Practice Address - Country:US
Practice Address - Phone:408-356-2061
Practice Address - Fax:408-356-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29588111N00000X
CAPT 2966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02695ZMedicare PIN