Provider Demographics
NPI:1710042890
Name:ROCKENMACHER, JEFFREY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:ROCKENMACHER
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 1:4152 KATELLA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6606
Mailing Address - Country:US
Mailing Address - Phone:562-598-9609
Mailing Address - Fax:562-799-1462
Practice Address - Street 1:4152 KATELLA AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6606
Practice Address - Country:US
Practice Address - Phone:562-598-9609
Practice Address - Fax:562-799-1462
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16035OtherCHIROPRACTIC LICENSE #
CADC16035OtherCHIROPRACTIC LICENSE #
CADC61035Medicare PIN