Provider Demographics
NPI:1942454285
Name:DAVEY, JACLYN CHRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:CHRISTINE
Last Name:DAVEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ALLENS CREEK RD STE 257
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3254
Mailing Address - Country:US
Mailing Address - Phone:931-933-1592
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD STE 257
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3254
Practice Address - Country:US
Practice Address - Phone:931-933-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN497171100000X, 171100000X
NY007466171100000X
TN13966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty