Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC29074 | CA |
N | 111NP0017X | Pediatric Chiropractor | 29074 | CA |
NPI | 1235469396 |
---|---|
Provider Name | Dr. Jennifer Kristin Lovern |
First Address | Coronado, CA 92118-1333 |
Second Address | San Marcos, CA 92069-2973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 17/03/2018 |