Healthcare Provider Details

I. General information

NPI: 1699854778
Provider Name (Legal Business Name): CYNTHIA JAFFE DC-NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 N RAVENSWOOD AVE
CHICAGO IL
60613-2420
US

IV. Provider business mailing address

28763 W MAIN ST
BARRINGTON IL
60010-1829
US

V. Phone/Fax

Practice location:
  • Phone: 847-830-8748
  • Fax:
Mailing address:
  • Phone: 847-830-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number03154
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10147917-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038008595
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60737810
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007523
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP5541
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9866
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009692
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: