Individual
JAELLE TAMARA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2625 DELAWARE AVE STE 102, BUFFALO, NY 14216-1705
(716) 335-9711
Mailing address
2625 DELAWARE AVE STE 102, BUFFALO, NY 14216-1705
(716) 335-9711
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
013139
NY
Other
Enumeration date
08/19/2018
Last updated
08/19/2018
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