Provider Demographics
NPI:1801079421
Name:JARED THOMAS CHIROPRACTIC CORPORATION, PC
Entity type:Organization
Organization Name:JARED THOMAS CHIROPRACTIC CORPORATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-780-1370
Mailing Address - Street 1:720 SUNRISE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4516
Mailing Address - Country:US
Mailing Address - Phone:916-780-1370
Mailing Address - Fax:916-780-1413
Practice Address - Street 1:720 SUNRISE AVE STE 104B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4508
Practice Address - Country:US
Practice Address - Phone:916-780-1370
Practice Address - Fax:916-780-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0287451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32785ZMedicare PIN