Provider Demographics
NPI:1528139789
Name:KARRAS, KENT EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:EDWARD
Last Name:KARRAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 FRONT ST
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6700
Mailing Address - Country:US
Mailing Address - Phone:619-252-4582
Mailing Address - Fax:619-702-9280
Practice Address - Street 1:601 E SAN YSIDRO BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3100
Practice Address - Country:US
Practice Address - Phone:619-662-9001
Practice Address - Fax:619-662-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor