Provider Demographics
NPI:1346642964
Name:EVERETT, DAVID J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:EVERETT
Suffix:
Gender:M
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:PO BOX 5383
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-0383
Mailing Address - Country:US
Mailing Address - Phone:626-643-8080
Mailing Address - Fax:
Practice Address - Street 1:11100 VALLEY BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2500
Practice Address - Country:US
Practice Address - Phone:626-643-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11129111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor