Provider Demographics
NPI:1245256288
Name:LARAINE, JOCELYN L (DC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:L
Last Name:LARAINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:L
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2121 NEWCASTLE AVE.
Mailing Address - Street 2:STE B
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007
Mailing Address - Country:US
Mailing Address - Phone:760-207-7223
Mailing Address - Fax:760-207-7223
Practice Address - Street 1:2121 NEWCASTLE AVE.
Practice Address - Street 2:STE B
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007
Practice Address - Country:US
Practice Address - Phone:760-207-7223
Practice Address - Fax:760-207-7223
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97568Medicare UPIN
CADC28004Medicare ID - Type Unspecified