Provider Demographics
NPI:1528227832
Name:KAKLEAS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KAKLEAS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY-BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-499-8469
Mailing Address - Street 1:4380 REDWOOD HWY
Mailing Address - Street 2:SUITE B6
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2120
Mailing Address - Country:US
Mailing Address - Phone:415-499-8469
Mailing Address - Fax:415-499-8645
Practice Address - Street 1:4380 REDWOOD HWY
Practice Address - Street 2:SUITE B6
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2120
Practice Address - Country:US
Practice Address - Phone:415-499-8469
Practice Address - Fax:415-499-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT109380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty