Provider Demographics
NPI:1104904374
Name:JANDA, ROBERT LYON (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYON
Last Name:JANDA
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 1:901 DOVER DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5538
Mailing Address - Country:US
Mailing Address - Phone:949-574-9239
Mailing Address - Fax:949-574-9316
Practice Address - Street 1:901 DOVER DR
Practice Address - Street 2:SUITE 122
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5538
Practice Address - Country:US
Practice Address - Phone:949-574-9239
Practice Address - Fax:949-574-9316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA14950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor