MEDICARE: JAMEY ANTHONY JACQUEMOUD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC28797	CA

General Provider Information

NPI Number	:	1063440725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMEY ANTHONY JACQUEMOUD D.C.

Provider Business Mailing Address
First Line	:	5440 MOREHOUSE DR
Second Line	:	SUITE 1700
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1798
Country	:	US
Telephone Number	:	858-455-7654
Fax Number	:	858-455-5014

Provider Business Practice Location Address
First Line	:	5440 MOREHOUSE DR
Second Line	:	SUITE 1700
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1798
Country	:	US
Telephone Number	:	858-455-7654
Fax Number	:	858-455-5014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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