Healthcare Provider Details

I. General information

NPI: 1831237353
Provider Name (Legal Business Name): JAMIE MARIE NOETH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PLANK ROAD
MONGAUP VALLEY NY
12762-0415
US

IV. Provider business mailing address

PO BOX 415 178 PLANK ROAD
MONGAUP VALLEY NY
12762-0415
US

V. Phone/Fax

Practice location:
  • Phone: 845-583-6151
  • Fax: 845-583-6299
Mailing address:
  • Phone: 845-583-6151
  • Fax: 845-583-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: