MEDICARE: JAFFE CHIROPRACTIC CLINIC INC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3453	NC

General Provider Information

NPI Number	:	1053490680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAFFE CHIROPRACTIC CLINIC INC PA

Provider Business Mailing Address
First Line	:	3230 PROSPERITY CHURCH RD
Second Line	:	SUITE 203
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8251
Country	:	US
Telephone Number	:	704-971-3275
Fax Number	:	704-971-3276

Provider Business Practice Location Address
First Line	:	3230 PROSPERITY CHURCH RD
Second Line	:	SUITE 203
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8251
Country	:	US
Telephone Number	:	704-971-3275
Fax Number	:	704-971-3276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN GLENN JAFFE
Credential	:	D.C.
Telephone Number	:	704-971-3275

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	05/09/2017

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