Provider Demographics
NPI:1477079796
Name:AHRENDT, JEREMY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:PAUL
Last Name:AHRENDT
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 1:520 W 17TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3614
Mailing Address - Country:US
Mailing Address - Phone:714-973-8911
Mailing Address - Fax:
Practice Address - Street 1:520 W 17TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3614
Practice Address - Country:US
Practice Address - Phone:714-973-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor