Provider Demographics
NPI:1215049549
Name:LISTIAK, JEFFREY K (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:LISTIAK
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 1:171 SAXONY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6776
Mailing Address - Country:US
Mailing Address - Phone:760-230-2939
Mailing Address - Fax:
Practice Address - Street 1:171 SAXONY RD STE 113
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6776
Practice Address - Country:US
Practice Address - Phone:760-230-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor