Provider Demographics
NPI:1639548415
Name:LIBS, JAY DANIEL (DC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:DANIEL
Last Name:LIBS
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 1:4410 LAMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4515
Mailing Address - Country:US
Mailing Address - Phone:858-483-8500
Mailing Address - Fax:858-272-0054
Practice Address - Street 1:4410 LAMONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4515
Practice Address - Country:US
Practice Address - Phone:858-483-8500
Practice Address - Fax:858-272-0054
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor