Provider Demographics
NPI:1629102009
Name:WESDORF, JAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:WESDORF
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 1:1100 PLEASANT VALLEY DR STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4362
Mailing Address - Country:US
Mailing Address - Phone:925-274-9900
Mailing Address - Fax:925-274-1146
Practice Address - Street 1:1100 PLEASANT VALLEY DR STE A
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4362
Practice Address - Country:US
Practice Address - Phone:925-274-9900
Practice Address - Fax:925-274-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0253950Medicare PIN