1922316868 NPI number — THE VALIANT JACOBS CHIROPRACTIC CORP

Table of content: SARAH A. THABET PT, DPT (NPI 1508205774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922316868 NPI number — THE VALIANT JACOBS CHIROPRACTIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VALIANT JACOBS CHIROPRACTIC CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922316868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 K STREET. SUITE 120C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-448-1770
Provider Business Mailing Address Fax Number:
916-448-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 POPPY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94070-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-218-8648
Provider Business Practice Location Address Fax Number:
650-594-4981
Provider Enumeration Date:
09/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
RITCH
Authorized Official Middle Name:
VALIANT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-218-8648

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC25246 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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