Provider Demographics
NPI:1770517906
Name:DVORSKY, JAY WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:WILLIAM
Last Name:DVORSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2701 OCEAN PARK BLVD
Mailing Address - Street 2:#108
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5200
Mailing Address - Country:US
Mailing Address - Phone:310-399-1885
Mailing Address - Fax:310-399-1505
Practice Address - Street 1:2701 OCEAN PARK BLVD
Practice Address - Street 2:#108
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5200
Practice Address - Country:US
Practice Address - Phone:310-399-1885
Practice Address - Fax:310-399-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19438111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition