Provider Demographics
NPI:1104829852
Name:SHERY, JAY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:J
Last Name:SHERY
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 1:10811 WASHINGTON BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3659
Mailing Address - Country:US
Mailing Address - Phone:310-841-5000
Mailing Address - Fax:310-841-5011
Practice Address - Street 1:10811 WASHINGTON BLVD
Practice Address - Street 2:STE 250
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3659
Practice Address - Country:US
Practice Address - Phone:310-841-5000
Practice Address - Fax:310-841-5011
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18615Medicare UPIN