Provider Demographics
NPI:1922292192
Name:GERVAIS, SOFFHEA K (DC)
Entity Type:Individual
Prefix:
First Name:SOFFHEA
Middle Name:K
Last Name:GERVAIS
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 1:1725 STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2598
Mailing Address - Country:US
Mailing Address - Phone:805-883-8982
Mailing Address - Fax:805-682-1365
Practice Address - Street 1:1725 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2598
Practice Address - Country:US
Practice Address - Phone:805-883-8982
Practice Address - Fax:805-682-1365
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor