Provider Demographics
NPI:1912202300
Name:MILUS, JENNIFER NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:MILUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:780 MAIN STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-3234
Mailing Address - Country:US
Mailing Address - Phone:925-858-4375
Mailing Address - Fax:844-235-1135
Practice Address - Street 1:5737 VALLEY AVE # D
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5250
Practice Address - Country:US
Practice Address - Phone:925-858-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor