Provider Demographics
NPI:1649468620
Name:VANDERFORD, JASON DAVID (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:VANDERFORD
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 1:6529 CORTE VALDEZ
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4556
Mailing Address - Country:US
Mailing Address - Phone:760-450-4346
Mailing Address - Fax:
Practice Address - Street 1:2555 TOWNSGATE RD
Practice Address - Street 2:STE. 125
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2697
Practice Address - Country:US
Practice Address - Phone:866-301-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25528111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology