Provider Demographics
NPI:1699820480
Name:PANCHUR, JENNIFER JANE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:PANCHUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JANE
Other - Last Name:PRIEBE-PANCHUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1197 HIGH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8282
Mailing Address - Country:US
Mailing Address - Phone:330-335-6070
Mailing Address - Fax:330-335-6080
Practice Address - Street 1:1197 HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8282
Practice Address - Country:US
Practice Address - Phone:330-335-6070
Practice Address - Fax:330-335-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106876Medicaid
OHPR0868222Medicare PIN
OHU74801Medicare UPIN
OHPA9354321Medicare PIN