Provider Demographics
NPI:1659542447
Name:CHURCH, JENNIFER SUE (DIPLAC,CA,CMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:DIPLAC,CA,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2521
Mailing Address - Country:US
Mailing Address - Phone:908-675-6363
Mailing Address - Fax:
Practice Address - Street 1:19 GREEN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2521
Practice Address - Country:US
Practice Address - Phone:908-675-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00060700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist