Provider Demographics
NPI:1972680247
Name:SERAFIN, JON JERROD (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:JERROD
Last Name:SERAFIN
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 1:1124 VINTNER WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6935
Mailing Address - Country:US
Mailing Address - Phone:925-525-5665
Mailing Address - Fax:209-858-1039
Practice Address - Street 1:16972 S HARLAN RD
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8738
Practice Address - Country:US
Practice Address - Phone:209-858-1029
Practice Address - Fax:209-858-1039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0249931Medicare ID - Type UnspecifiedLATHROP
CADC0249930Medicare ID - Type UnspecifiedPLEASANTON