Provider Demographics
NPI:1881088722
Name:TABLAK, JULIET MARIE (DC)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:MARIE
Last Name:TABLAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SAN ANTONIO RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4632
Mailing Address - Country:US
Mailing Address - Phone:323-687-9137
Mailing Address - Fax:
Practice Address - Street 1:744 SAN ANTONIO RD
Practice Address - Street 2:SUITE 10
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4632
Practice Address - Country:US
Practice Address - Phone:323-687-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor