Provider Demographics
NPI:1053404095
Name:KALSBEEK, BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KALSBEEK
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 1:21168 REDWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5932
Mailing Address - Country:US
Mailing Address - Phone:510-582-4880
Mailing Address - Fax:510-582-5408
Practice Address - Street 1:21168 REDWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5932
Practice Address - Country:US
Practice Address - Phone:510-582-4880
Practice Address - Fax:510-582-5408
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 11753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0117530Medicare PIN