Provider Demographics
NPI:1679990782
Name:JAGTAR S DHESI DC A CHIROPRACTIC CORP
Entity type:Organization
Organization Name:JAGTAR S DHESI DC A CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGTAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHESI
Authorized Official - Suffix:
Authorized Official - Credentials:DC ACHIROPRACTICCORP
Authorized Official - Phone:925-606-6373
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-0657
Mailing Address - Country:US
Mailing Address - Phone:925-606-6373
Mailing Address - Fax:925-606-6680
Practice Address - Street 1:947 BLUEBELL DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-5319
Practice Address - Country:US
Practice Address - Phone:925-606-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27413111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE905AMedicare UPIN