Provider Demographics
NPI:1285266759
Name:JERICHO CHIROPRACTIC LLC
Entity type:Organization
Organization Name:JERICHO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-899-5400
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-0063
Mailing Address - Country:US
Mailing Address - Phone:802-899-5400
Mailing Address - Fax:802-899-5497
Practice Address - Street 1:397 ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-2044
Practice Address - Country:US
Practice Address - Phone:802-899-5400
Practice Address - Fax:802-355-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty