Provider Demographics
NPI:1154615748
Name:YANKO, JENNIFER LYNN (DIPLLAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:YANKO
Suffix:
Gender:F
Credentials:DIPLLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1286
Mailing Address - Country:US
Mailing Address - Phone:973-634-0462
Mailing Address - Fax:
Practice Address - Street 1:68 1ST AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1286
Practice Address - Country:US
Practice Address - Phone:973-634-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00061500111NS0005X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No251300000XAgenciesLocal Education Agency (LEA)