Provider Demographics
NPI:1346615119
Name:JEFFREY KWAN PREMIER CHIROPRACTIC
Entity Type:Organization
Organization Name:JEFFREY KWAN PREMIER CHIROPRACTIC
Other - Org Name:PREMIER CHIROPRACTIC OF ARCADIA
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-888-1773
Mailing Address - Street 1:411 E HUNTINGTON DR STE 119
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3788
Mailing Address - Country:US
Mailing Address - Phone:626-888-1773
Mailing Address - Fax:
Practice Address - Street 1:411 E HUNTINGTON DR STE 119
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3788
Practice Address - Country:US
Practice Address - Phone:626-888-1773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty