Provider Demographics
NPI:1063440725
Name:JACQUEMOUD, JAMEY ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:ANTHONY
Last Name:JACQUEMOUD
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 1:5440 MOREHOUSE DR
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1798
Mailing Address - Country:US
Mailing Address - Phone:858-455-7654
Mailing Address - Fax:858-455-5014
Practice Address - Street 1:5440 MOREHOUSE DR
Practice Address - Street 2:SUITE 1700
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1798
Practice Address - Country:US
Practice Address - Phone:858-455-7654
Practice Address - Fax:858-455-5014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28797Medicare ID - Type Unspecified