Provider Demographics
NPI:1710192455
Name:MOUNTAIN, KELVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:MOUNTAIN
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 1:7801 MISSION CENTER CT STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1314
Mailing Address - Country:US
Mailing Address - Phone:619-858-2005
Mailing Address - Fax:619-858-2008
Practice Address - Street 1:7801 MISSION CENTER CT STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1314
Practice Address - Country:US
Practice Address - Phone:619-858-2005
Practice Address - Fax:619-858-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor