Healthcare Provider Details

I. General information

NPI: 1669873782
Provider Name (Legal Business Name): JBJC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S FAIRMONT AVE SUITE G
LODI CA
95240-3860
US

IV. Provider business mailing address

534 E PINE ST SUITE A
STOCKTON CA
95204-5536
US

V. Phone/Fax

Practice location:
  • Phone: 209-339-1690
  • Fax: 209-339-1693
Mailing address:
  • Phone: 209-463-5800
  • Fax: 209-463-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN K BOB
Title or Position: DPT / OWNER / PRESIDENT
Credential: DPT
Phone: 209-451-3920