Provider Demographics
NPI:1174817191
Name:CAYUGA CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:CAYUGA CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-387-5771
Mailing Address - Street 1:203 E MAIN ST
Mailing Address - Street 2:P.O. BOX 1057
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-8908
Mailing Address - Country:US
Mailing Address - Phone:607-387-5771
Mailing Address - Fax:607-387-3000
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-8908
Practice Address - Country:US
Practice Address - Phone:607-387-5771
Practice Address - Fax:607-387-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011988302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization