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General NPI Number Information
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NPI Number | 1174817191
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Entity Type | Organization
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Legal Business Name | CAYUGA CHIROPRACTIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 203 E MAIN ST
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City | TRUMANSBURG
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State | NY
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Zip | 14886-8908
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Country | US
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Telephone | 607-387-5771
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Fax | 607-387-3000
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Provider Business Mailing Address
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Address Line | 203 E MAIN ST P.O. BOX 1057
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City | TRUMANSBURG
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State | NY
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Zip | 14886-8908
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Country | US
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Telephone | 607-387-5771
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Fax | 607-387-3000
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. JESSICA LYNN JORDAN
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Credential | D.C.
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Telephone | 607-387-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 011988
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License Number State | NY
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