Jodi Nichole Dinnerman, DC
Individual provider Active NPI Chiropractor · Clinton, NJ
NPI 1003013897 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1003013897
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- MC05797 (NJ)
- Practice address
- 16 Leigh St
Ste 1C
Clinton, NJ 08809-1412 - Phone
- (908) 238-1081
- NPI assigned
- Jun 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC05797 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | MC05797 | NJ | Yes |
Addresses
Primary practice location
16 Leigh St
Ste 1C
Clinton, NJ 08809-1412
Mailing address
23 Northwood Dr
Pittstown, NJ 08867-5129
Phone (908) 735-9355
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201073024 | Other | NJ | TAX ID |
Other names
- Lightsource Chiropractic
Other providers in Clinton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.