Provider Demographics
NPI:1740869338
Name:DAMBRA, JACLYN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MARIE
Last Name:DAMBRA
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 1:9301 SUMMIT CENTRE WAY UNIT 1314
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6097
Mailing Address - Country:US
Mailing Address - Phone:516-547-0672
Mailing Address - Fax:
Practice Address - Street 1:877 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6522
Practice Address - Country:US
Practice Address - Phone:407-889-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor