Provider Demographics
NPI:1902348907
Name:KIRK, DAVID (ND)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KIRK
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4415
Mailing Address - Country:US
Mailing Address - Phone:510-459-1459
Mailing Address - Fax:
Practice Address - Street 1:3414 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4415
Practice Address - Country:US
Practice Address - Phone:510-459-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath