Provider Demographics
NPI:1770590234
Name:PEARSON, JEFFREY GLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLEN
Last Name:PEARSON
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 1:1907 INTREPID WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7037
Mailing Address - Country:US
Mailing Address - Phone:760-434-9454
Mailing Address - Fax:760-434-9453
Practice Address - Street 1:2575 PIO PICO DR STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1561
Practice Address - Country:US
Practice Address - Phone:760-434-9454
Practice Address - Fax:760-434-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor