Healthcare Provider Details

I. General information

NPI: 1649468620
Provider Name (Legal Business Name): JASON DAVID VANDERFORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 TOWNSGATE RD STE. 125
WESTLAKE VILLAGE CA
91361-2697
US

IV. Provider business mailing address

6529 CORTE VALDEZ
CARLSBAD CA
92009-4556
US

V. Phone/Fax

Practice location:
  • Phone: 866-301-6568
  • Fax:
Mailing address:
  • Phone: 760-450-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC 25528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: