Provider Demographics
NPI:1740317619
Name:JANCO-PLOURDE, SHARON LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNN
Last Name:JANCO-PLOURDE
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:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1927
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:909-878-3228
Practice Address - Street 1:41945 BIG BEAR BLVD
Practice Address - Street 2:SUITES 221, 222, 223
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1927
Practice Address - Country:US
Practice Address - Phone:909-866-5070
Practice Address - Fax:909-878-3228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA17326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0017326Medicaid
CA17326OtherSTATE LICENSE
CA17326OtherSTATE LICENSE
CA17326OtherSTATE LICENSE
CADC0017326Medicaid