Provider Demographics
NPI:1881226116
Name:REMILLARD, IANNICK (DC,CCSP, ATC)
Entity type:Individual
Prefix:DR
First Name:IANNICK
Middle Name:
Last Name:REMILLARD
Suffix:
Gender:M
Credentials:DC,CCSP, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 MOORPARK AVE
Mailing Address - Street 2:SUITE 20/21
Mailing Address - City:SAN JOSE CA
Mailing Address - State:CA
Mailing Address - Zip Code:95117
Mailing Address - Country:US
Mailing Address - Phone:408-493-2200
Mailing Address - Fax:
Practice Address - Street 1:4155 MOORPARK AVE
Practice Address - Street 2:SUITE 20/21
Practice Address - City:SAN JOSE CA
Practice Address - State:CA
Practice Address - Zip Code:95117
Practice Address - Country:US
Practice Address - Phone:408-493-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor