Provider Demographics
NPI:1447288899
Name:WENTE-MOELLER, JENNIFER M (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WENTE-MOELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:607 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3176
Mailing Address - Country:US
Mailing Address - Phone:614-235-8199
Mailing Address - Fax:614-235-8646
Practice Address - Street 1:607 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3176
Practice Address - Country:US
Practice Address - Phone:614-235-8199
Practice Address - Fax:614-235-8646
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048304Medicaid
OHU71256Medicare UPIN
OHSP01931Medicare PIN
OH2048304Medicaid