Provider Demographics
NPI:1558587758
Name:PONTON, DOROTHY (DC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:PONTON
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 1:3151 OLIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1635
Mailing Address - Country:US
Mailing Address - Phone:408-377-9555
Mailing Address - Fax:
Practice Address - Street 1:3151 OLIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1635
Practice Address - Country:US
Practice Address - Phone:408-377-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0264750OtherBLUE SHIELD PIN
U92344Medicare UPIN
CADC0264750OtherBLUE SHIELD PIN