Provider Demographics
NPI:1144592171
Name:DR. JEANINE ELIZABETH, LLC
Entity Type:Organization
Organization Name:DR. JEANINE ELIZABETH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZABETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-777-2322
Mailing Address - Street 1:172 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2137
Mailing Address - Country:US
Mailing Address - Phone:978-777-2322
Mailing Address - Fax:978-774-0724
Practice Address - Street 1:172 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2137
Practice Address - Country:US
Practice Address - Phone:978-777-2322
Practice Address - Fax:978-774-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty