Provider Demographics
NPI:1205536984
Name:AMADOR-CASTELLANOS, JESSICA (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:AMADOR-CASTELLANOS
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 1:406 S PROSPECTORS RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1659
Mailing Address - Country:US
Mailing Address - Phone:909-860-0148
Mailing Address - Fax:
Practice Address - Street 1:406 S PROSPECTORS RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1659
Practice Address - Country:US
Practice Address - Phone:909-860-0148
Practice Address - Fax:909-860-9348
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty