Provider Demographics
NPI:1508089947
Name:FORD, JEROLD R (DC)
Entity Type:Individual
Prefix:MR
First Name:JEROLD
Middle Name:R
Last Name:FORD
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 1:1208 FLOYD AVE
Mailing Address - Street 2:STE B6
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2454
Mailing Address - Country:US
Mailing Address - Phone:209-549-8090
Mailing Address - Fax:209-549-8094
Practice Address - Street 1:1208 FLOYD AVE
Practice Address - Street 2:STE B6
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2454
Practice Address - Country:US
Practice Address - Phone:209-549-8090
Practice Address - Fax:209-549-8094
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAN92117766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor