Provider Demographics
NPI:1477789238
Name:JAROSZ, JENNAFER ANNE (DC)
Entity Type:Individual
Prefix:
First Name:JENNAFER
Middle Name:ANNE
Last Name:JAROSZ
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 1:588 WILLIAM LATHAM DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2326
Mailing Address - Country:US
Mailing Address - Phone:815-932-7800
Mailing Address - Fax:815-932-7806
Practice Address - Street 1:588 WILLIAM LATHAM DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2326
Practice Address - Country:US
Practice Address - Phone:815-932-7800
Practice Address - Fax:815-932-7806
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11947189OtherCAQH