Provider Demographics
NPI:1518176833
Name:SPURBACK, JODI ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:ANN
Last Name:SPURBACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:NASCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:636 N FRENCH RD
Mailing Address - Street 2:SUITES 9 & 10
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1900
Mailing Address - Country:US
Mailing Address - Phone:716-417-6887
Mailing Address - Fax:716-688-2200
Practice Address - Street 1:636 N FRENCH RD
Practice Address - Street 2:SUITES 9 & 10
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1900
Practice Address - Country:US
Practice Address - Phone:716-417-6887
Practice Address - Fax:716-688-2200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0415Medicare ID - Type Unspecified
NYU98961Medicare UPIN