Provider Demographics
NPI:1538222617
Name:HAKE, JENNIFER KISSANE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KISSANE
Last Name:HAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ERIN
Other - Last Name:KISSANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-661-6629
Mailing Address - Fax:203-661-9861
Practice Address - Street 1:11 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-661-6629
Practice Address - Fax:203-661-9861
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001278111N00000X
NYX007920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor