Healthcare Provider Details

I. General information

NPI: 1457805434
Provider Name (Legal Business Name): JENNIFER ILENE NOLAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 REDWOOD RD STE 7
OAKLAND CA
94619-2400
US

IV. Provider business mailing address

5707 REDWOOD RD STE 7
OAKLAND CA
94619-2400
US

V. Phone/Fax

Practice location:
  • Phone: 510-610-9210
  • Fax:
Mailing address:
  • Phone: 510-610-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33656
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC33656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: