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Organization
STATE OF THE HEART WELLNESS
Active
Organization
STATE OF THE HEART WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TINA ROACH-GAGNON DC (OWNER 50/50)
(408) 972-5686
Entity
Organization
Contact information
Practice address
7174 SANTA TERESA BLVD STE A7, SAN JOSE, CA 95139-1350
(408) 972-5686
(408) 972-5682
Mailing address
7174 SANTA TERESA BLVD STE A7, SAN JOSE, CA 95139-1350
(408) 972-5686
(408) 972-5682
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC23580
CA
Other
Enumeration date
02/02/2017
Last updated
03/30/2017
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