Provider Demographics
NPI:1407819386
Name:JESPERSON, R CHRISTIAN (DC)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:CHRISTIAN
Last Name:JESPERSON
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 1:1333 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3434
Mailing Address - Country:US
Mailing Address - Phone:619-444-4792
Mailing Address - Fax:619-444-4892
Practice Address - Street 1:1333 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3434
Practice Address - Country:US
Practice Address - Phone:619-444-4792
Practice Address - Fax:619-444-4892
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407819386OtherBLUE CROSS BLUE SHIELD OF CALIFORNIA
CA830345045 0006OtherCIGNA PROVIDER #
CA830345045AOtherCALIF IRONWORKERS
KY0004488663OtherAETNA PIN #
CA830345045OtherTAX ID
CA1407819386OtherBLUE CROSS OF CALIFONIA
CA830345045 BOtherHEALTH NET
MD830345045-003OtherGBS GRP BENEFITS
CA1457485080OtherNPI TYPE-2
CAXXXXX7205 92021 0000OtherTRICARE
CA830345045AOtherCALIF IRONWORKERS
CA1407819386OtherBLUE CROSS OF CALIFONIA