Healthcare Provider Details

I. General information

NPI: 1134262470
Provider Name (Legal Business Name): JACQUES EUGENE ALLMAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E 17TH ST STE B
COSTA MESA CA
92627-7706
US

IV. Provider business mailing address

140 E 17TH ST STE B
COSTA MESA CA
92627-7706
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-1699
  • Fax: 714-963-5979
Mailing address:
  • Phone: 949-722-1699
  • Fax: 714-963-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC24269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: