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NPI Code Detail

MEDICARE: JODI EICHINGER JOCKS M.S., R.D.

MEDICARE: JODI EICHINGER JOCKS M.S., R.D.
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
1133V00000XRegistered Dietitian873100MI

General Provider Information

NPI Number : 1679834733
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODI EICHINGER JOCKS M.S., R.D.
Provider Business Mailing Address
First Line : 615 W 10TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3138
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 US HIGHWAY 31 SOUTH
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-8016
Country : US
Telephone Number : 989-497-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 05/29/2024

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