Provider Demographics
NPI:1063869345
Name:MACRIS, JANE (DC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:MACRIS
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 1:2845 MESA VERDE DR E STE 6D
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4858
Mailing Address - Country:US
Mailing Address - Phone:657-845-1669
Mailing Address - Fax:
Practice Address - Street 1:2845 MESA VERDE DR E STE 6D
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4858
Practice Address - Country:US
Practice Address - Phone:657-845-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33047111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor