Provider Demographics
NPI:1780605667
Name:EBADAT, ASGHAR JAY (DC)
Entity type:Individual
Prefix:MR
First Name:ASGHAR
Middle Name:JAY
Last Name:EBADAT
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 1:1066 SARATOGA AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3432
Mailing Address - Country:US
Mailing Address - Phone:408-244-6555
Mailing Address - Fax:408-244-9251
Practice Address - Street 1:1066 SARATOGA AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3432
Practice Address - Country:US
Practice Address - Phone:408-244-6555
Practice Address - Fax:408-244-9251
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23836ZMedicare ID - Type UnspecifiedCHIROPRACTIC