Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | MC05797 | NJ |
NPI | 1003013897 |
---|---|
Provider Name | Dr. Jodi Nichole Dinnerman |
First Address | Pittstown, NJ 08867-5129 |
Second Address | Clinton, NJ 08809-1412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201073024 | TAX ID (01) | NJ |