Doctor Name: | MR. WILLIAM KEITH MODENBACH |
NPI Number: | 1720149487 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 19538 |
Business Practice Address: | 43 Quail Court #202 Walnut Creek, CA - 94596 |
Business Phone Number: | 9259441478 |
Business Fax Number: | |
Mailing Address: | 1738 Stanley Dollar Drive, #2b WALNUT CREEK |
State: | CA |
Postal Code: | 94595 |
Phone Number: | 9259359700 |
Fax Number: | 9259359914 |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 19538 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |