Provider Demographics
NPI:1407055049
Name:RATZLAFF, JEROMY DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEROMY
Middle Name:DEAN
Last Name:RATZLAFF
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 1:27725 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6704
Mailing Address - Country:US
Mailing Address - Phone:949-855-1887
Mailing Address - Fax:949-855-3213
Practice Address - Street 1:27725 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6704
Practice Address - Country:US
Practice Address - Phone:949-855-1887
Practice Address - Fax:949-855-3213
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871712406OtherNPI NUMBER
CAW18792Medicare PIN
CA1871712406OtherNPI NUMBER