Provider Demographics
NPI:1336488071
Name:PRICE, JENNIFER L (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PRICE
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 1:925 LAKEVILLE ST
Mailing Address - Street 2:#331
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:707-776-6932
Mailing Address - Fax:
Practice Address - Street 1:8499 OLD REDWOOD HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492
Practice Address - Country:US
Practice Address - Phone:707-838-8300
Practice Address - Fax:707-838-9097
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor