Provider Demographics
NPI:1619048360
Name:KIRCHER, THEO H JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THEO
Middle Name:H
Last Name:KIRCHER
Suffix:JR
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 1:2555 CAMINO DEL RIO S. #201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-283-7283
Mailing Address - Fax:619-283-7285
Practice Address - Street 1:2555 CAMINO DEL RIO S STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-283-7283
Practice Address - Fax:619-283-7285
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17228AMedicare ID - Type Unspecified