Healthcare Provider Details

I. General information

NPI: 1477079796
Provider Name (Legal Business Name): JEREMY PAUL AHRENDT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W 17TH ST STE 3
SANTA ANA CA
92706-3614
US

IV. Provider business mailing address

520 W 17TH ST STE 3
SANTA ANA CA
92706-3614
US

V. Phone/Fax

Practice location:
  • Phone: 714-973-8911
  • Fax:
Mailing address:
  • Phone: 714-973-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: