Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X003480-1 | NY |
NPI | 1003954702 |
---|---|
Provider Name | Susann Jones |
First Address | Woodside, NY 11377 |
Second Address | Woodside, NY 11377-3254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 12/10/2007 |