Provider Demographics
NPI:1093908253
Name:JEFFREY A. PAULSEN, CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:JEFFREY A. PAULSEN, CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-472-4007
Mailing Address - Street 1:22972 EL TORO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4961
Mailing Address - Country:US
Mailing Address - Phone:949-472-4007
Mailing Address - Fax:949-472-4028
Practice Address - Street 1:22972 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4961
Practice Address - Country:US
Practice Address - Phone:949-472-4007
Practice Address - Fax:949-472-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18046Medicare UPIN