Provider Demographics
NPI:1134343080
Name:JOSE, KALANI (DC, FICPA, IDE)
Entity type:Individual
Prefix:DR
First Name:KALANI
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:DC, FICPA, IDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 OUTLET CENTER DR STE 330
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0612
Mailing Address - Country:US
Mailing Address - Phone:805-604-0881
Mailing Address - Fax:805-604-0883
Practice Address - Street 1:2100 OUTLET CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0612
Practice Address - Country:US
Practice Address - Phone:805-604-0881
Practice Address - Fax:805-604-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25976111N00000X
HIDC826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25976Medicare ID - Type Unspecified