Derry Sontag, D.C.
Individual provider Active NPI Chiropractor · Moss Beach, CA
NPI 1508037631 · NPPES record last updated Mar 17, 2008
Key facts
- NPI
- 1508037631
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC29103 (CA)
- Practice address
- 2305 Carlos St
B
Moss Beach, CA 94038-9666 - Phone
- (650) 728-7106
- Fax
- (650) 728-5459
- NPI assigned
- Mar 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC29103 | CA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC29103 | CA | Yes |
Addresses
Primary practice location
2305 Carlos St
B
Moss Beach, CA 94038-9666
Mailing address
15550 Rockfield Blvd
B220
Irvine, CA 92618-2720
Phone (949) 598-9999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC29103 | Other | CA | LICENSE |
Other providers in Moss Beach, CA
- Manuela Seitz-Hipkins
- Seton Coastside Emergency Medical Associates Inc
- Seton Medical Center
- Seton Medical Center
- Seton Medical Center Coatside
- Matthew Joseph Vuksinich
All providers in Moss Beach, CA · Chiropractor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.