Jaclyn Marie Nicodemo, LMT

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC009420 Issued in PA

Practice address

970 Pulaski Dr
King of Prussia, PA 19406-2802

Phone

(610) 640-9355

NPI assigned

May 2, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Marie Nicodemo Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellness Quest Chiropractic

  • Chiropractor
  • King of Prussia, PA
  • NPI 1619177110
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1972248128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 ROSS RD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 PULASKI DR",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062802",
            "telephone_number": "610-640-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 E Beidler Rd",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194061929",
            "country_code": "US",
            "telephone_number": "610-265-7323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICODEMO",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-02",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "wellnessquestchiropractic.com",
            "affiliation": "N",
            "endpointDescription": "1-individual",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "970 Pulaski Dr",
            "city": "King Of Prussia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "194062802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "NICODEMO",
            "middle_name": "MARIE",
            "credential": "JACLYN TASSONI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa Newell
• Michael Newell
• Lorene Newman, CRNA
• Andy Nguyen
• My Le Nguyen, PHARMD
• Nicole Marie Nutrition LLC
• Gabriel Arturo Noble Cruz, MD
• Obed Antonio Nogueda
• Neeka Dimples Noje-Murray, LSW
• Nordstrom Inc & Subsidiaries

• Chiropractor in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.