Provider Demographics
NPI:1710323134
Name:KREIDER, JONYELLE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JONYELLE
Middle Name:NICOLE
Last Name:KREIDER
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:PO BOX 2637
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-2637
Mailing Address - Country:US
Mailing Address - Phone:813-833-9552
Mailing Address - Fax:
Practice Address - Street 1:1218 MILLENNIUM PKWY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3895
Practice Address - Country:US
Practice Address - Phone:813-833-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor