Provider Demographics
NPI:1003185265
Name:AMRINE, JACALYN REANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACALYN
Middle Name:REANE
Last Name:AMRINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 QUARTZ WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2929
Mailing Address - Country:US
Mailing Address - Phone:530-246-0317
Mailing Address - Fax:
Practice Address - Street 1:2089 QUARTZ WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2929
Practice Address - Country:US
Practice Address - Phone:530-246-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor