=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427174531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNINE LEE STEWART-WELSH D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 03/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 824 W 15TH ST #4
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-675-8820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5826 E BONNYVIEW RD
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-675-8820
-----------------------------------------------------
Fax | 530-215-3970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 016542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------