Provider Demographics
NPI:1861692220
Name:AL GHURAIBAWI, JENNIFER ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:AL GHURAIBAWI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13024 US HIGHWAY 70W
Mailing Address - Street 2:STE 101
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-600-1725
Mailing Address - Fax:919-573-9691
Practice Address - Street 1:843 WAKE FOREST BUSINESS PARK STE 102
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6578
Practice Address - Country:US
Practice Address - Phone:919-600-1725
Practice Address - Fax:919-573-9691
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001690111N00000X
NC4524111N00000X
NYX0009079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5K61Medicare PIN