Healthcare Provider Details

I. General information

NPI: 1104816495
Provider Name (Legal Business Name): VICKI LYNN JOBE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 COLBOURN PL
OAKLAND CA
94619-3508
US

IV. Provider business mailing address

5655 COLBOURN PL
OAKLAND CA
94619-3508
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8775
  • Fax: 510-531-5890
Mailing address:
  • Phone: 510-268-8775
  • Fax: 510-531-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number00002332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: