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General NPI Number Information
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NPI Number | 1548992282
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Entity Type | Individual
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Provider Name | JACOB LILLEY DC
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 11728 HAYVENHURST AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2945
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Country | US
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Telephone | 818-808-7308
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Fax |
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Provider Business Mailing Address
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Address Line | 11728 HAYVENHURST AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2945
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Country | US
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Telephone | 818-808-7308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC36381
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License Number State | CA
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