Provider Demographics
NPI:1134105539
Name:FORCEY PORTER, JODI K (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:K
Last Name:FORCEY PORTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SPRUCE ALLEY
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-1304
Mailing Address - Country:US
Mailing Address - Phone:814-378-8687
Mailing Address - Fax:814-378-7740
Practice Address - Street 1:706 SPRUCE ALLEY
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651-1304
Practice Address - Country:US
Practice Address - Phone:814-378-8687
Practice Address - Fax:814-378-7740
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004997L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA350035933OtherRAILROAD MEDICARE
PA424706OtherBLUE CROSS/BLUE SHIELD
PA0013048240003Medicaid
PA0013048240003Medicaid