Provider Demographics
NPI:1033535802
Name:JANDIAL, SIDHARTHA (DC)
Entity Type:Individual
Prefix:
First Name:SIDHARTHA
Middle Name:
Last Name:JANDIAL
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 1:199 CALIFORNIA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-3118
Mailing Address - Country:US
Mailing Address - Phone:650-692-2273
Mailing Address - Fax:
Practice Address - Street 1:199 CALIFORNIA DR STE 100
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-3118
Practice Address - Country:US
Practice Address - Phone:650-692-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor