Healthcare Provider Details

I. General information

NPI: 1982768727
Provider Name (Legal Business Name): JONATHAN MATTEW ESCOBAR D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 RESEDA BLVD SUITE 301
NORTHRIDGE CA
91324-2310
US

IV. Provider business mailing address

9535 RESEDA BLVD SUITE 301
NORTHRIDGE CA
91324-2310
US

V. Phone/Fax

Practice location:
  • Phone: 818-718-1975
  • Fax: 818-718-2259
Mailing address:
  • Phone: 818-718-1975
  • Fax: 818-718-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: