Provider Demographics
NPI:1134163678
Name:HOFFMAN, KEVIN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 CLAIREMONT MESA BLVD
Mailing Address - Street 2:STE. 303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1040
Mailing Address - Country:US
Mailing Address - Phone:858-627-9220
Mailing Address - Fax:858-627-9223
Practice Address - Street 1:7051 CLAIREMONT MESA BLVD
Practice Address - Street 2:STE. 303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1040
Practice Address - Country:US
Practice Address - Phone:858-627-9220
Practice Address - Fax:858-627-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330341589OtherFEDERAL TAX ID
CA330341589OtherFEDERAL TAX ID