Provider Demographics
NPI:1952465940
Name:J. HJELMSTAD INC
Entity Type:Organization
Organization Name:J. HJELMSTAD INC
Other - Org Name:INLAND VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HJELMSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-676-8686
Mailing Address - Street 1:29377 RANCHO CALIFORNIA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5206
Mailing Address - Country:US
Mailing Address - Phone:951-676-8686
Mailing Address - Fax:951-676-5158
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5206
Practice Address - Country:US
Practice Address - Phone:951-676-8686
Practice Address - Fax:951-676-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 220060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22006OtherSTATE LIC NUMBER
CADC0220060OtherBLUE CROSS
CADC0220060OtherBLUE SHIELD
CA22006OtherSTATE LIC NUMBER
CADC0220060Medicare PIN