Provider Demographics
NPI:1194772228
Name:TEITELBAUM, JAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:TEITELBAUM
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 1:26440 LA ALAMEDA
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6304
Mailing Address - Country:US
Mailing Address - Phone:949-215-4500
Mailing Address - Fax:949-348-2396
Practice Address - Street 1:26440 LA ALAMEDA
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6304
Practice Address - Country:US
Practice Address - Phone:949-215-4500
Practice Address - Fax:949-348-2396
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0278750OtherBS
CADC0278750OtherBS