Provider Demographics
NPI:1336877604
Name:JENNIFER L STANTON DC
Entity Type:Organization
Organization Name:JENNIFER L STANTON DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-712-4104
Mailing Address - Street 1:14 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1596
Mailing Address - Country:US
Mailing Address - Phone:315-712-4104
Mailing Address - Fax:315-293-2247
Practice Address - Street 1:14 STATE ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1596
Practice Address - Country:US
Practice Address - Phone:315-712-4104
Practice Address - Fax:315-293-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05576807Medicaid
11124559OtherCAQH