Provider Demographics
NPI:1619007796
Name:CACANINDIN, JENNIFER JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:CACANINDIN
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 1:901 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1559
Mailing Address - Country:US
Mailing Address - Phone:847-251-6766
Mailing Address - Fax:847-256-9874
Practice Address - Street 1:901 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1559
Practice Address - Country:US
Practice Address - Phone:847-251-6766
Practice Address - Fax:847-256-9874
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor