Provider Demographics
NPI:1982862447
Name:DZENDZEL, JOSEPH DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:DZENDZEL
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 1:3650 CLAIREMONT DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5908
Mailing Address - Country:US
Mailing Address - Phone:858-272-7002
Mailing Address - Fax:
Practice Address - Street 1:3650 CLAIREMONT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5908
Practice Address - Country:US
Practice Address - Phone:858-272-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26381Medicare PIN