Provider Demographics
NPI:1669502340
Name:NEITHOLD NASH, JAMIE KATHRYN (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KATHRYN
Last Name:NEITHOLD NASH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:NEITHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660
Mailing Address - Country:US
Mailing Address - Phone:508-394-9355
Mailing Address - Fax:508-394-9355
Practice Address - Street 1:38 ROUTE 134
Practice Address - Street 2:SUITE 1
Practice Address - City:S DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660
Practice Address - Country:US
Practice Address - Phone:508-394-9355
Practice Address - Fax:508-394-9355
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36434OtherBLUE CROSS BLUE SHIELD
MAY36434OtherBLUE CROSS BLUE SHIELD