Provider Demographics
NPI:1265658033
Name:CHIAVETTA-GRISANTI, JENNIFER J (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:CHIAVETTA-GRISANTI
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 1:3315 63RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5410
Mailing Address - Country:US
Mailing Address - Phone:941-358-6716
Mailing Address - Fax:
Practice Address - Street 1:3315 63RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5410
Practice Address - Country:US
Practice Address - Phone:941-358-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010990-1111N00000X
FLCH10011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor