Provider Demographics
NPI:1750500112
Name:COLEMAN, JOHN EDWARD II (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:COLEMAN
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2355 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:#102
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1523
Mailing Address - Country:US
Mailing Address - Phone:925-406-4344
Mailing Address - Fax:925-406-4408
Practice Address - Street 1:2355 SAN RAMON VALLEY BLVD
Practice Address - Street 2:#102
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1523
Practice Address - Country:US
Practice Address - Phone:925-406-4344
Practice Address - Fax:925-406-4408
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA25557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC025570Medicare ID - Type Unspecified