Provider Demographics
NPI:1831510411
Name:JO, MI (DC)
Entity type:Individual
Prefix:
First Name:MI
Middle Name:
Last Name:JO
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 1:720 E PALISADE AVE
Mailing Address - Street 2:SUITE# 202
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3053
Mailing Address - Country:US
Mailing Address - Phone:201-567-7100
Mailing Address - Fax:
Practice Address - Street 1:720 E PALISADE AVE
Practice Address - Street 2:SUITE# 202
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3053
Practice Address - Country:US
Practice Address - Phone:201-567-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00705300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor