Provider Demographics
NPI:1104013945
Name:COLLAZO, JEAN SOCORRO (DC)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:SOCORRO
Last Name:COLLAZO
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 1:400 N FORD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1122
Mailing Address - Country:US
Mailing Address - Phone:323-262-9222
Mailing Address - Fax:323-262-9261
Practice Address - Street 1:400 N FORD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1122
Practice Address - Country:US
Practice Address - Phone:323-262-9222
Practice Address - Fax:323-262-9261
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor