Healthcare Provider Details

I. General information

NPI: 1700980976
Provider Name (Legal Business Name): JASON DENNIS REZANSOFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31944 HILLTOP BLVD
RUNNING SPRINGS CA
92382-2671
US

IV. Provider business mailing address

PO BOX 2671 31944 HILLTOP BLVD
RUNNING SPRINGS CA
92382-2671
US

V. Phone/Fax

Practice location:
  • Phone: 909-867-5547
  • Fax: 909-867-5487
Mailing address:
  • Phone: 909-867-5547
  • Fax: 909-867-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: