Provider Demographics
NPI:1720555790
Name:MUXEN, JACKLYN RENEE (DC)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:RENEE
Last Name:MUXEN
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 1:1314 LINCOLN AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3012
Mailing Address - Country:US
Mailing Address - Phone:408-975-9753
Mailing Address - Fax:
Practice Address - Street 1:1314 LINCOLN AVE STE 2E
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3012
Practice Address - Country:US
Practice Address - Phone:408-975-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34346111N00000X, 111NP0017X, 111NS0005X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty