Provider Demographics
NPI:1417170648
Name:INSPIRED HEALTH CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:INSPIRED HEALTH CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LODA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-256-0641
Mailing Address - Street 1:726 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3215
Mailing Address - Country:US
Mailing Address - Phone:607-256-0641
Mailing Address - Fax:
Practice Address - Street 1:726 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3215
Practice Address - Country:US
Practice Address - Phone:607-256-0641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010724-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598836140OtherCHIROPRACTOR
NYDD7079Medicare ID - Type UnspecifiedCHIROPRACTOR
NYU96894Medicare UPIN