Provider Demographics
NPI:1467782078
Name:BAXLEY, JANE (DC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BAXLEY
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 1:2819 CROW CANYON RD STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1657
Mailing Address - Country:US
Mailing Address - Phone:925-406-3222
Mailing Address - Fax:
Practice Address - Street 1:2819 CROW CANYON RD STE 213
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1657
Practice Address - Country:US
Practice Address - Phone:925-406-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31454OtherLICENSE