Provider Demographics
NPI:1821214941
Name:ROCKWELL, KIRK ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ALLEN
Last Name:ROCKWELL
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 1:5 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3765
Mailing Address - Country:US
Mailing Address - Phone:415-897-6179
Mailing Address - Fax:
Practice Address - Street 1:711 D ST
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3707
Practice Address - Country:US
Practice Address - Phone:415-456-6160
Practice Address - Fax:415-457-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC025375Medicare ID - Type Unspecified