Provider Demographics
NPI:1568592798
Name:COATS, KRISTIAN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:ANTHONY
Last Name:COATS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15466 LOS GATOS BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2551
Mailing Address - Country:US
Mailing Address - Phone:408-402-0404
Mailing Address - Fax:408-402-0606
Practice Address - Street 1:15466 LOS GATOS BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2551
Practice Address - Country:US
Practice Address - Phone:408-402-0404
Practice Address - Fax:408-402-0606
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor