Provider Demographics
NPI:1689684631
Name:BALL, JENNETTE JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNETTE
Middle Name:JOAN
Last Name:BALL
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 1:75 NELSON ST
Mailing Address - Street 2:TOWN AND COUNTRY PLAZA
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1322
Mailing Address - Country:US
Mailing Address - Phone:315-655-2230
Mailing Address - Fax:315-655-2230
Practice Address - Street 1:75 NELSON ST
Practice Address - Street 2:TOWN AND COUNTRY PLAZA
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1322
Practice Address - Country:US
Practice Address - Phone:315-655-2230
Practice Address - Fax:315-655-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5243Medicare PIN