Provider Demographics
NPI:1588914733
Name:CHAN, JEFFREY ALEXANDER (DC, CSCS, ART)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALEXANDER
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC, CSCS, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 ADDISON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1700
Mailing Address - Country:US
Mailing Address - Phone:415-519-8376
Mailing Address - Fax:
Practice Address - Street 1:1250 ADDISON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1700
Practice Address - Country:US
Practice Address - Phone:510-883-1126
Practice Address - Fax:510-883-9926
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32375111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation