Provider Demographics
NPI:1003614934
Name:AVALOS, JESUS ALEXANDER (DC)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ALEXANDER
Last Name:AVALOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 GRISMER AVE APT R
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3621
Mailing Address - Country:US
Mailing Address - Phone:747-283-4675
Mailing Address - Fax:
Practice Address - Street 1:1141 N BRAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2577
Practice Address - Country:US
Practice Address - Phone:818-484-8944
Practice Address - Fax:818-484-8943
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor