Provider Demographics
NPI:1720117179
Name:JOLY, JOSEPH JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:JOLY
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 1:3909 STEVENSON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2312
Mailing Address - Country:US
Mailing Address - Phone:510-249-9037
Mailing Address - Fax:510-249-9659
Practice Address - Street 1:3909 STEVENSON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2312
Practice Address - Country:US
Practice Address - Phone:510-249-9037
Practice Address - Fax:510-249-9659
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28962111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician