Healthcare Provider Details

I. General information

NPI: 1659899318
Provider Name (Legal Business Name): JEANA MARIE EDWARDS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 11TH ST
SAN JOSE CA
95112-2217
US

IV. Provider business mailing address

300 S 11TH ST
SAN JOSE CA
95112-2217
US

V. Phone/Fax

Practice location:
  • Phone: 408-600-1188
  • Fax: 408-280-7844
Mailing address:
  • Phone: 408-600-1188
  • Fax: 408-280-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: