Provider Demographics
NPI:1558485193
Name:WESTCOTT, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:WESTCOTT
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 1:29671 6 MILE RD
Mailing Address - Street 2:STE 110C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4555
Mailing Address - Country:US
Mailing Address - Phone:734-427-1579
Mailing Address - Fax:734-427-0976
Practice Address - Street 1:29701 SIX MILE RD
Practice Address - Street 2:STE 150A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-427-1579
Practice Address - Fax:734-427-0976
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJW007223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H253380OtherBCBS
CODRHMedicare UPIN
MI0M27940Medicare ID - Type Unspecified