Provider Demographics
NPI:1053490680
Name:JAFFE CHIROPRACTIC CLINIC INC PA
Entity Type:Organization
Organization Name:JAFFE CHIROPRACTIC CLINIC INC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-971-3275
Mailing Address - Street 1:3230 PROSPERITY CHURCH RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8251
Mailing Address - Country:US
Mailing Address - Phone:704-971-3275
Mailing Address - Fax:704-971-3276
Practice Address - Street 1:3230 PROSPERITY CHURCH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8251
Practice Address - Country:US
Practice Address - Phone:704-971-3275
Practice Address - Fax:704-971-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty