Provider Demographics
NPI:1700120755
Name:AMARO, JACLYN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MARIE
Last Name:AMARO
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 1:161 E ERIE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2827
Mailing Address - Country:US
Mailing Address - Phone:312-337-5777
Mailing Address - Fax:
Practice Address - Street 1:161 E ERIE ST STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2827
Practice Address - Country:US
Practice Address - Phone:312-337-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO12256-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor