Provider Demographics
NPI:1952488504
Name:CONSTABLE, JENNIFER L (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:CONSTABLE
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 141 35928 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13782-0141
Mailing Address - Country:US
Mailing Address - Phone:607-746-8225
Mailing Address - Fax:607-746-8225
Practice Address - Street 1:35928 STATE HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-0141
Practice Address - Country:US
Practice Address - Phone:607-746-8225
Practice Address - Fax:607-746-8225
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X5B941Medicare ID - Type Unspecified