Provider Demographics
NPI:1255323713
Name:BUTTON-WELLER, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:BUTTON-WELLER
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 1:446 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-1353
Mailing Address - Country:US
Mailing Address - Phone:570-278-1134
Mailing Address - Fax:570-278-1134
Practice Address - Street 1:446 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-1353
Practice Address - Country:US
Practice Address - Phone:570-278-1134
Practice Address - Fax:570-278-1134
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU1583485OtherBCBS
PA85838OtherGEISINGER HEALTH PLAN
1051347OtherAMER SPEC HEALTH NETWORK
PA817563OtherFPH
1051347OtherAMER SPEC HEALTH NETWORK
PA076730Medicare PIN