Provider Demographics
NPI:1265898738
Name:KAKIZAKI, JEANNIE ROSE (DC)
Entity type:Individual
Prefix:
First Name:JEANNIE ROSE
Middle Name:
Last Name:KAKIZAKI
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 1:826 E 4TH AVE
Mailing Address - Street 2:A
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:826 E 4TH AVE
Practice Address - Street 2:A
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3317
Practice Address - Country:US
Practice Address - Phone:509-432-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor