Provider Demographics
NPI:1225207707
Name:ON, JACQUELINE T (DC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:T
Last Name:ON
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 1:17150 EUCLID ST STE 222
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4092
Mailing Address - Country:US
Mailing Address - Phone:714-438-2487
Mailing Address - Fax:714-438-0597
Practice Address - Street 1:17150 EUCLID ST STE 222
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-438-2487
Practice Address - Fax:714-438-0597
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor