Provider Demographics
NPI:1518550250
Name:FAYDENKO, JOCELYN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:L
Last Name:FAYDENKO
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 1:2102 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3223
Mailing Address - Country:US
Mailing Address - Phone:989-330-7906
Mailing Address - Fax:
Practice Address - Street 1:2102 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3223
Practice Address - Country:US
Practice Address - Phone:989-330-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor