Provider Demographics
NPI:1205919081
Name:ROBBINS, JAY R (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:ROBBINS
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 1:245 W BADILLO ST STE E
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1923
Mailing Address - Country:US
Mailing Address - Phone:626-967-6461
Mailing Address - Fax:626-332-4264
Practice Address - Street 1:245 W BADILLO ST STE E
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1923
Practice Address - Country:US
Practice Address - Phone:626-967-6461
Practice Address - Fax:626-332-4264
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20369111NN1001X
CA20369DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3394768OtherTAX ID
CA95-3394768OtherTAX ID
CA95-3394768OtherTAX ID
CADC20369Medicare UPIN