Provider Demographics
NPI:1205849775
Name:JARDIN, DAN (DC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:JARDIN
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 1:7351 BRENTWOOD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2058
Mailing Address - Country:US
Mailing Address - Phone:925-516-5813
Mailing Address - Fax:925-516-5943
Practice Address - Street 1:7351 BRENTWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2058
Practice Address - Country:US
Practice Address - Phone:925-516-5813
Practice Address - Fax:925-516-5943
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251460Medicare ID - Type UnspecifiedCHIROPRACTIC