Provider Demographics
NPI:1134387947
Name:PRESTON, JOHN JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAY
Last Name:PRESTON
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 1:166 FOX LN
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-2086
Mailing Address - Country:US
Mailing Address - Phone:951-375-1636
Mailing Address - Fax:951-304-1534
Practice Address - Street 1:166 FOX LN
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-2086
Practice Address - Country:US
Practice Address - Phone:951-375-1636
Practice Address - Fax:951-304-1534
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor