Provider Demographics
NPI:1982747259
Name:OWEN, JONICE MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:JONICE
Middle Name:MAE
Last Name:OWEN
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 1:5901 CHRISTIE AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1934
Mailing Address - Country:US
Mailing Address - Phone:510-652-4532
Mailing Address - Fax:510-652-6204
Practice Address - Street 1:5901 CHRISTIE AVE STE 307
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1934
Practice Address - Country:US
Practice Address - Phone:510-652-4532
Practice Address - Fax:510-652-6204
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18903111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0189030Medicare ID - Type Unspecified