Provider Demographics
NPI:1578551115
Name:CACERES, JENNY P (DC, PA)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:P
Last Name:CACERES
Suffix:
Gender:F
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6489 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2940
Mailing Address - Country:US
Mailing Address - Phone:305-648-2502
Mailing Address - Fax:305-648-2102
Practice Address - Street 1:495 BILTMORE WAY
Practice Address - Street 2:SUITE #302
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5756
Practice Address - Country:US
Practice Address - Phone:305-648-2502
Practice Address - Fax:305-648-2102
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55889OtherBC / BS
FLU99953Medicare UPIN
FL55889OtherBC / BS