Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1931 | MA |
NPI | 1003093089 |
---|---|
Provider Name | Dr. Jennifer Marie Connors |
First Address | Fiskdale, MA 01518-0659 |
Second Address | Fiskdale, MA 01518-1290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y45023 | (02) | MA |