Provider Demographics
NPI:1235682907
Name:JEAN S. COLLAZO, D.C. INC
Entity Type:Organization
Organization Name:JEAN S. COLLAZO, D.C. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-262-9222
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty