Healthcare Provider Details

I. General information

NPI: 1720117179
Provider Name (Legal Business Name): JOSEPH JOHN JOLY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 STEVENSON BLVD SUITE D
FREMONT CA
94538-2312
US

IV. Provider business mailing address

3909 STEVENSON BLVD SUITE D
FREMONT CA
94538-2312
US

V. Phone/Fax

Practice location:
  • Phone: 510-249-9037
  • Fax: 510-249-9659
Mailing address:
  • Phone: 510-249-9037
  • Fax: 510-249-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC28962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: