Provider Demographics
NPI:1619103926
Name:DIMEO, JENNIFER MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHAEL
Last Name:DIMEO
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 1:880 47TH ST
Mailing Address - Street 2:APT D2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2321
Mailing Address - Country:US
Mailing Address - Phone:718-813-6602
Mailing Address - Fax:
Practice Address - Street 1:44 E 32ND ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5508
Practice Address - Country:US
Practice Address - Phone:718-813-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01041-6111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor