Healthcare Provider Details

I. General information

NPI: 1720071962
Provider Name (Legal Business Name): JEFFREY MONAHAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 S BREA CANYON RD #F
DIAMOND BAR CA
91765-3481
US

IV. Provider business mailing address

13895 PLUMROSE PL
CHINO HILLS CA
91709-5935
US

V. Phone/Fax

Practice location:
  • Phone: 909-598-7868
  • Fax: 909-598-4428
Mailing address:
  • Phone: 909-464-9987
  • Fax: 909-598-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: