Provider Demographics
NPI:1184841728
Name:KAKLEAS, JON MARK (DC, PT)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:MARK
Last Name:KAKLEAS
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 REDWOOD HIGHWAY, STE. B-6
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-499-8469
Mailing Address - Fax:415-499-8645
Practice Address - Street 1:4380 REDWOOD HWY STE B6
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2110
Practice Address - Country:US
Practice Address - Phone:415-499-8469
Practice Address - Fax:415-499-8645
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23537111N00000X
CAPT 109380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 023537Medicare ID - Type UnspecifiedCHIROPRACTOR
CAOPT 109380Medicare ID - Type UnspecifiedPHYSICAL THERAPIST