Healthcare Provider Details

I. General information

NPI: 1497316087
Provider Name (Legal Business Name): CJ JARVIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 ADAMS AVE
SAN DIEGO CA
92116-1645
US

IV. Provider business mailing address

3239 ADAMS AVE
SAN DIEGO CA
92116-1645
US

V. Phone/Fax

Practice location:
  • Phone: 619-546-4806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number67825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: