Provider Demographics
NPI:1063957785
Name:JE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:JE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-742-7777
Mailing Address - Street 1:4515 CENTRAL AVE
Mailing Address - Street 2:STE.202
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2396
Mailing Address - Country:US
Mailing Address - Phone:951-742-7777
Mailing Address - Fax:951-742-7700
Practice Address - Street 1:4515 CENTRAL AVE
Practice Address - Street 2:STE.202
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2396
Practice Address - Country:US
Practice Address - Phone:951-742-7777
Practice Address - Fax:951-742-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty