Provider Demographics
NPI:1871703983
Name:BOTSFORD, JERRY M (DC)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:BOTSFORD
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 1:1200 MT DIABLO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4800
Mailing Address - Country:US
Mailing Address - Phone:925-937-8832
Mailing Address - Fax:
Practice Address - Street 1:1200 MT DIABLO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4800
Practice Address - Country:US
Practice Address - Phone:925-937-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor