Provider Demographics
NPI:1366593295
Name:WORSMAN, JENNIFER (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WORSMAN
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 1:36 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1217
Mailing Address - Country:US
Mailing Address - Phone:860-317-1212
Mailing Address - Fax:860-317-1379
Practice Address - Street 1:36 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1217
Practice Address - Country:US
Practice Address - Phone:860-317-1212
Practice Address - Fax:860-317-1379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001267CT02OtherANTHEM BC AND BS
CT004223880Medicaid
U80534Medicare UPIN
CT004223880Medicaid