Healthcare Provider Details

I. General information

NPI: 1295873206
Provider Name (Legal Business Name): JEANNE HOFVENDAHL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 HIGHWAY 9
BEN LOMOND CA
95005-9703
US

IV. Provider business mailing address

7969 HWY 9
BEN LOMOND CA
95005-9317
US

V. Phone/Fax

Practice location:
  • Phone: 831-336-3076
  • Fax: 831-336-1917
Mailing address:
  • Phone: 831-336-3076
  • Fax: 831-336-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: