Basic Information
| Provider Information | |||||||||
| NPI: | 1598767642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DANTE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 S OAK KNOLL AVE APT 101 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268252621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 W WALNUT ST STE 375 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911241220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232579600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | DC22376 | CA | N | Chiropractic Providers | Chiropractor | Sports Physician | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.