Healthcare Provider Details

I. General information

NPI: 1134683766
Provider Name (Legal Business Name): CHRISTOPHER JEPSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date: 12/02/2019
Reactivation Date: 04/15/2020

III. Provider practice location address

9040 FRIARS RD # 401
SAN DIEGO CA
92108-5859
US

IV. Provider business mailing address

9040 FRIARS RD # 401
SAN DIEGO CA
92108-5859
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-0201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: