Provider Demographics
NPI:1083894042
Name:ROWENA DE JESUS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ROWENA DE JESUS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-708-2228
Mailing Address - Street 1:298 ROCK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3211
Mailing Address - Country:US
Mailing Address - Phone:570-708-2228
Mailing Address - Fax:570-708-2039
Practice Address - Street 1:298 ROCK GLEN RD
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3211
Practice Address - Country:US
Practice Address - Phone:570-708-2228
Practice Address - Fax:570-708-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty