Provider Demographics
NPI:1457385080
Name:JESPERSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:JESPERSON CHIROPRACTIC INC
Other - Org Name:CHIROPRACTIC FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:JESPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-444-4792
Mailing Address - Street 1:1333 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3434
Mailing Address - Country:US
Mailing Address - Phone:619-444-4792
Mailing Address - Fax:619-444-4892
Practice Address - Street 1:1333 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3434
Practice Address - Country:US
Practice Address - Phone:619-444-4792
Practice Address - Fax:619-444-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457385080Medicare UPIN