Provider Demographics
NPI:1508950742
Name:LYNNE, JENNIFER ELYSE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELYSE
Last Name:LYNNE
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 1:114 WOODSIDE GRN APT 2C
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4913
Mailing Address - Country:US
Mailing Address - Phone:203-355-0689
Mailing Address - Fax:
Practice Address - Street 1:1867 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5016
Practice Address - Country:US
Practice Address - Phone:203-975-7000
Practice Address - Fax:203-975-0876
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001402CT01OtherBLUE CROSS ID