Provider Demographics
NPI:1225102585
Name:JAMISON, PATRICIA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:JAMISON
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 1:14 FOREST AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5208
Mailing Address - Country:US
Mailing Address - Phone:862-210-8994
Mailing Address - Fax:
Practice Address - Street 1:14 FOREST AVE STE 11
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5208
Practice Address - Country:US
Practice Address - Phone:862-210-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00397800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223134224OtherTAX ID