Provider Demographics
NPI:1013606276
Name:TAVE, JENNIFER (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TAVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WHITEHALL LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3686
Mailing Address - Country:US
Mailing Address - Phone:650-644-8433
Mailing Address - Fax:
Practice Address - Street 1:505 SEAPORT CT STE 103
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-5574
Practice Address - Country:US
Practice Address - Phone:650-542-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor