05D2091158 CLIA NUMBER - JESSE G DEFRESE DC

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Laboratory Demographics

CLIA Number: 05D2091158

Facility Name: JESSE G DEFRESE DC

Facility Address:
423 F ST STE 109
DAVIS, CA
ZIP 95616
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Facility Phone Number: 530 758-8654

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578652913

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	05D2091158
LAB Type	Physician Office
Facility Name	JESSE G DEFRESE DC
Street	423 F ST STE 109
City	DAVIS
State	CA
ZIP	95616
Phone	530 758-8654
CertificateType	4
CertificateEffectiveDate	2/6/2023
CertificateExpirationDate	2/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024