Provider Demographics
NPI:1659899318
Name:EDWARDS, JEANA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANA
Middle Name:MARIE
Last Name:EDWARDS
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 1:300 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2217
Mailing Address - Country:US
Mailing Address - Phone:408-600-1188
Mailing Address - Fax:408-280-7844
Practice Address - Street 1:300 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2217
Practice Address - Country:US
Practice Address - Phone:408-600-1188
Practice Address - Fax:408-280-7844
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor