Provider Demographics
NPI:1073123618
Name:JANDIAL CORP
Entity Type:Organization
Organization Name:JANDIAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDHARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-274-5308
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0327
Mailing Address - Country:US
Mailing Address - Phone:650-726-3300
Mailing Address - Fax:
Practice Address - Street 1:455 AVENUE ALHAMBRA # 5
Practice Address - Street 2:
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018-8132
Practice Address - Country:US
Practice Address - Phone:650-726-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty