Provider Demographics
NPI:1255369252
Name:KAIBEL, JERILYNN SUE (DC)
Entity type:Individual
Prefix:
First Name:JERILYNN
Middle Name:SUE
Last Name:KAIBEL
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 1:851 E 6TH ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2217
Mailing Address - Country:US
Mailing Address - Phone:951-845-1931
Mailing Address - Fax:951-845-0557
Practice Address - Street 1:851 E 6TH ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2217
Practice Address - Country:US
Practice Address - Phone:951-845-1931
Practice Address - Fax:951-845-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13347ZMedicare ID - Type Unspecified