Provider Demographics
NPI:1962566885
Name:ROSENCRANS, JACQUI LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUI
Middle Name:LYNN
Last Name:ROSENCRANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WEST PACIFIC COAST HWY
Mailing Address - Street 2:#234
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-631-1440
Mailing Address - Fax:949-631-1410
Practice Address - Street 1:2700 W. PACIFIC COAST HWY
Practice Address - Street 2:#234
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-631-1440
Practice Address - Fax:949-631-1410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor