Provider Demographics
NPI:1740616523
Name:ROCKWELL, JEFFEREY ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFEREY
Middle Name:ALLAN
Last Name:ROCKWELL
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 1:317 POTRERO ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-7611
Mailing Address - Country:US
Mailing Address - Phone:831-425-9500
Mailing Address - Fax:888-959-1186
Practice Address - Street 1:317 POTRERO ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-7611
Practice Address - Country:US
Practice Address - Phone:831-425-9500
Practice Address - Fax:888-959-1186
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31516111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation