Provider Demographics
NPI:1669787636
Name:SIRUCEK ADEPOJU, JILLIAN MARJORIE (DC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARJORIE
Last Name:SIRUCEK ADEPOJU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:MARJORIE
Other - Last Name:SIRUCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:964 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3505
Mailing Address - Country:US
Mailing Address - Phone:208-515-1080
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON ST N STE 400
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3874
Practice Address - Country:US
Practice Address - Phone:208-736-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor