Provider Demographics
NPI:1235328634
Name:KO, JENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3525 OLD CONEJO RD STE 119
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6133
Mailing Address - Country:US
Mailing Address - Phone:805-300-0333
Mailing Address - Fax:805-375-0332
Practice Address - Street 1:3525 OLD CONEJO RD STE 119
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6133
Practice Address - Country:US
Practice Address - Phone:805-300-0333
Practice Address - Fax:805-375-0332
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor