# EAST BAY PAIN CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417325317
- **Authorized official:** DAN JARDIN (OWNER)
- **Authorized official phone:** (925) 516-5656

## Contact information

- **Practice address:** 7351 BRENTWOOD BLVD STE A, BRENTWOOD, CA 94513-2058
- **Practice address phone:** (925) 516-5656
- **Practice address fax:** (925) 516-5943
- **Mailing address:** 7351 BRENTWOOD BLVD STE A, BRENTWOOD, CA 94513-2058
- **Mailing address phone:** (925) 516-5656
- **Mailing address fax:** (925) 516-5943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | DC25146 | CA | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | A128252 | CA | — |
| 208VP0000X | Pain Medicine Physician | A128252 | CA | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | A128252 | CA | — |

## Other

- **Enumeration date:** 09/09/2015
- **Last updated:** 09/09/2015