Provider Demographics
NPI:1659739811
Name:CHEVALIER SPORTS CHIROPRACTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CHEVALIER SPORTS CHIROPRACTIC ASSOCIATES, PC
Other - Org Name:TEAM CLINIC SPORTS THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:MATHIEU
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACBSP
Authorized Official - Phone:408-241-8326
Mailing Address - Street 1:1265 EL CAMINO REAL
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4257
Mailing Address - Country:US
Mailing Address - Phone:408-241-8326
Mailing Address - Fax:408-241-2600
Practice Address - Street 1:1265 EL CAMINO REAL
Practice Address - Street 2:SUITE 180
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4257
Practice Address - Country:US
Practice Address - Phone:408-241-8326
Practice Address - Fax:408-241-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21269111NS0005X
CA14765171100000X
CA13931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty