Provider Demographics
NPI:1922146703
Name:KAISER-COLE, MARY BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:KAISER-COLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 HONOLULU AVE STE M
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1842
Mailing Address - Country:US
Mailing Address - Phone:818-957-1207
Mailing Address - Fax:818-797-3048
Practice Address - Street 1:2418 HONOLULU AVE STE M
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1842
Practice Address - Country:US
Practice Address - Phone:818-957-1207
Practice Address - Fax:818-797-3048
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954810270OtherTAX ID NUMBER
CADC22731Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
CADC22731Medicare UPIN