Provider Demographics
NPI:1881984433
Name:HERSHEY, LAURA JAYE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JAYE
Last Name:HERSHEY
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 1:4783 PESCADERO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3540
Mailing Address - Country:US
Mailing Address - Phone:619-222-5299
Mailing Address - Fax:
Practice Address - Street 1:4783 PESCADERO AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3540
Practice Address - Country:US
Practice Address - Phone:619-222-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19833OtherCHIROPRACTIC LICENSE NUMBER