Healthcare Provider Details

I. General information

NPI: 1043547490
Provider Name (Legal Business Name): JENNA M LEMON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 E FOOTHILL BLVD 105
PASADENA CA
91107-3466
US

IV. Provider business mailing address

2623 E FOOTHILL BLVD 105
PASADENA CA
91107-3466
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-2639
  • Fax: 626-796-2673
Mailing address:
  • Phone: 626-796-2639
  • Fax: 626-796-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: