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General NPI Number Information
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NPI Number | 1679993745
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Entity Type | Organization
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Legal Business Name | JACLYN BORZA MAHER, D.C., PLLC
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 726 WILLOW AVE
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City | ITHACA
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State | NY
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Zip | 14850-3215
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Country | US
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Telephone | 607-256-0641
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 N CAYUGA ST
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City | ITHACA
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State | NY
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Zip | 14850-3616
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Country | US
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Telephone | 607-256-0641
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACLYN BORZA MAHER
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Credential | D.C.
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Telephone | 315-730-7199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012461-1
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License Number State | NY
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