Healthcare Provider Details

I. General information

NPI: 1255369252
Provider Name (Legal Business Name): JERILYNN SUE KAIBEL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 6TH ST SUITE B-1
BEAUMONT CA
92223-2217
US

IV. Provider business mailing address

851 E 6TH ST SUITE B-1
BEAUMONT CA
92223-2217
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1931
  • Fax: 951-845-0557
Mailing address:
  • Phone: 951-845-1931
  • Fax: 951-845-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: