Provider Demographics
NPI:1750196903
Name:FIELDS, JAYSON KYLE JR
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:KYLE
Last Name:FIELDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 E PACIFIC COAST HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4841
Mailing Address - Country:US
Mailing Address - Phone:562-493-5600
Mailing Address - Fax:
Practice Address - Street 1:6324 E PACIFIC COAST HWY STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4841
Practice Address - Country:US
Practice Address - Phone:562-493-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor