Provider Demographics
NPI:1073941423
Name:JARROD S. WILNER, DC, PA
Entity Type:Organization
Organization Name:JARROD S. WILNER, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:754-551-7611
Mailing Address - Street 1:PO BOX 813270
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-3270
Mailing Address - Country:US
Mailing Address - Phone:754-551-7611
Mailing Address - Fax:754-551-7611
Practice Address - Street 1:5840 SW 32ND TER
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6323
Practice Address - Country:US
Practice Address - Phone:754-551-7611
Practice Address - Fax:754-551-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty