Provider Demographics
NPI:1689810251
Name:PURCELL, JACLYN NOELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:NOELLE
Last Name:PURCELL
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 1:376 BROADWAY STE L4
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3162
Mailing Address - Country:US
Mailing Address - Phone:518-886-8189
Mailing Address - Fax:518-886-8099
Practice Address - Street 1:376 BROADWAY STE L4
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3162
Practice Address - Country:US
Practice Address - Phone:518-886-8189
Practice Address - Fax:518-886-8099
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor