Healthcare Provider Details

I. General information

NPI: 1134387947
Provider Name (Legal Business Name): JOHN JAY PRESTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 FOX LN
CALIMESA CA
92320-2086
US

IV. Provider business mailing address

166 FOX LN
CALIMESA CA
92320-2086
US

V. Phone/Fax

Practice location:
  • Phone: 951-375-1636
  • Fax: 951-304-1534
Mailing address:
  • Phone: 951-375-1636
  • Fax: 951-304-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: