Provider Demographics
NPI:1891067708
Name:BLACK, JACHIN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACHIN
Middle Name:LEE
Last Name:BLACK
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 1:1506 PERSHING DR
Mailing Address - Street 2:APT. A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94129-3351
Mailing Address - Country:US
Mailing Address - Phone:415-269-5881
Mailing Address - Fax:
Practice Address - Street 1:1506 PERSHING DR
Practice Address - Street 2:APT. A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-3351
Practice Address - Country:US
Practice Address - Phone:415-269-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor