Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | X013348 | NY |
NPI | 1396322327 |
---|---|
Provider Name | Jessica Driscoll |
First Address | Brooklyn, NY 11211-3907 |
Second Address | Brooklyn, NY 11249-4123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 25/03/2021 |