Provider Demographics
NPI:1699854778
Name:JAFFE, CYNTHIA (DC-NP-C)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:DC-NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28763 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1829
Mailing Address - Country:US
Mailing Address - Phone:847-830-8748
Mailing Address - Fax:
Practice Address - Street 1:3940 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2420
Practice Address - Country:US
Practice Address - Phone:847-830-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03154363L00000X
UT10147917-4405363L00000X
IL038008595111NI0900X
WA60737810363L00000X
CA95007523363L00000X
MNNP5541363L00000X
AZAP9866363LF0000X
IL209009692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111NI0900XChiropractic ProvidersChiropractorInternist