Provider Demographics
NPI:1710456926
Name:JIMMY JIMENEZ CHIROPRACTIC INC
Entity Type:Organization
Organization Name:JIMMY JIMENEZ CHIROPRACTIC INC
Other - Org Name:SAN PEDRO HEALTH AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:424-732-3012
Mailing Address - Street 1:1351 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3515
Mailing Address - Country:US
Mailing Address - Phone:424-732-3012
Mailing Address - Fax:424-232-8502
Practice Address - Street 1:1351 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3515
Practice Address - Country:US
Practice Address - Phone:424-732-3012
Practice Address - Fax:424-232-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty