Provider Demographics
NPI:1518143528
Name:EICHHORST CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:EICHHORST CHIROPRACTIC CORPORATION
Other - Org Name:GRACE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHHORST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-262-6620
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty