Provider Demographics
NPI:1508122524
Name:SETO, JENNA LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LOUISE
Last Name:SETO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LOUISE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11610 IBERIA PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2407
Mailing Address - Country:US
Mailing Address - Phone:858-848-5671
Mailing Address - Fax:
Practice Address - Street 1:11610 IBERIA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2407
Practice Address - Country:US
Practice Address - Phone:858-848-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGB288AOtherMEDICARE PTAN