Provider Demographics
NPI:1689861486
Name:WELCH, JENNIFER LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:WELCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 GREENMANVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2753
Mailing Address - Country:US
Mailing Address - Phone:860-536-6888
Mailing Address - Fax:860-536-6889
Practice Address - Street 1:2 GREENMANVILLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2753
Practice Address - Country:US
Practice Address - Phone:860-536-6888
Practice Address - Fax:860-536-6889
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001687111N00000X
IDCHIA-1191111N00000X
NH770-0806111N00000X
WY664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor