Provider Demographics
NPI:1740602200
Name:KREISBERG, JOEL (DC, CCH)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:KREISBERG
Suffix:
Gender:M
Credentials:DC, CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1926
Mailing Address - Country:US
Mailing Address - Phone:510-558-7285
Mailing Address - Fax:
Practice Address - Street 1:863 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1926
Practice Address - Country:US
Practice Address - Phone:510-558-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28109111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition