Provider Demographics
NPI:1720071962
Name:MONAHAN, JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MONAHAN
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 1:13895 PLUMROSE PL
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5935
Mailing Address - Country:US
Mailing Address - Phone:909-464-9987
Mailing Address - Fax:909-598-4428
Practice Address - Street 1:3220 S BREA CANYON RD
Practice Address - Street 2:#F
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3481
Practice Address - Country:US
Practice Address - Phone:909-598-7868
Practice Address - Fax:909-598-4428
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19355DCMedicare ID - Type Unspecified