Provider Demographics
NPI:1255973673
Name:CORE, JACQUELYN JORDON
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:JORDON
Last Name:CORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 YMCA LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4174
Mailing Address - Country:US
Mailing Address - Phone:724-438-2584
Mailing Address - Fax:724-438-4503
Practice Address - Street 1:1 YMCA LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4174
Practice Address - Country:US
Practice Address - Phone:724-438-2584
Practice Address - Fax:724-438-4503
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer