Provider Demographics
NPI:1932647021
Name:JBJC INC
Entity Type:Organization
Organization Name:JBJC INC
Other - Org Name:PINE STREET PHYSICAL & OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPT, OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-451-3920
Mailing Address - Street 1:534 E PINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:1640 W YOSEMITE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5192
Practice Address - Country:US
Practice Address - Phone:209-463-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23015ZMedicare PIN