Provider Demographics
NPI:1609862101
Name:KIDD, WILLIAM RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:KIDD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:W.
Other - Middle Name:RICHARD
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1231 FRANKLIN MALL # 241
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4806
Mailing Address - Country:US
Mailing Address - Phone:408-248-8392
Mailing Address - Fax:
Practice Address - Street 1:1265 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050
Practice Address - Country:US
Practice Address - Phone:408-248-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12446111N00000X, 111N00000X
IDCHIA 371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04766Medicare UPIN
CADC0124461Medicare PIN