Provider Demographics
NPI:1013160639
Name:JJCG, INC.
Entity type:Organization
Organization Name:JJCG, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIAVETTA-GRISANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-434-1780
Mailing Address - Street 1:5875 S TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6340
Mailing Address - Country:US
Mailing Address - Phone:716-434-1780
Mailing Address - Fax:716-434-3868
Practice Address - Street 1:5875 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6340
Practice Address - Country:US
Practice Address - Phone:716-434-1780
Practice Address - Fax:716-434-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0407Medicare PIN
NYV03364Medicare UPIN