Provider Demographics
NPI:1780659326
Name:BAE, JIMMY (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:BAE
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 1:4345 E LOWELL ST STE A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2223
Mailing Address - Country:US
Mailing Address - Phone:909-730-7713
Mailing Address - Fax:
Practice Address - Street 1:5471 LA PALMA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-4700
Practice Address - Country:US
Practice Address - Phone:562-468-0023
Practice Address - Fax:562-468-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA812628307OtherCHIROPRACTIC