Healthcare Provider Details

I. General information

NPI: 1689684631
Provider Name (Legal Business Name): JENNETTE JOAN BALL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NELSON ST TOWN AND COUNTRY PLAZA
CAZENOVIA NY
13035-1322
US

IV. Provider business mailing address

75 NELSON ST TOWN AND COUNTRY PLAZA
CAZENOVIA NY
13035-1322
US

V. Phone/Fax

Practice location:
  • Phone: 315-655-2230
  • Fax: 315-655-2230
Mailing address:
  • Phone: 315-655-2230
  • Fax: 315-655-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: