Healthcare Provider Details

I. General information

NPI: 1598941221
Provider Name (Legal Business Name): JARRET LEE WELSH D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 RIO SAN DIEGO DR SUITE 347
SAN DIEGO CA
92108-1624
US

IV. Provider business mailing address

8885 RIO SAN DIEGO DR SUITE 347
SAN DIEGO CA
92108-1624
US

V. Phone/Fax

Practice location:
  • Phone: 619-293-3453
  • Fax: 619-216-1444
Mailing address:
  • Phone: 619-293-3453
  • Fax: 619-216-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC30724
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC30724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: