Healthcare Provider Details

I. General information

NPI: 1669747143
Provider Name (Legal Business Name): JOB J ASAD D.C., B.SC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 BOULEVARD WAY SUITE 106
WALNUT CREEK CA
94595-1125
US

IV. Provider business mailing address

1280 BOULEVARD WAY SUITE 106
WALNUT CREEK CA
94595-1125
US

V. Phone/Fax

Practice location:
  • Phone: 925-289-8011
  • Fax:
Mailing address:
  • Phone: 925-289-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number34521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: