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NPI Code Detail

MEDICARE: DR. DAVID VEREEN JESSOP JR. DOCTOR OF CHIROPRACT

MEDICARE: DR. DAVID VEREEN JESSOP JR. DOCTOR OF CHIROPRACT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCHIA-1514ID

General Provider Information

NPI Number : 1972850212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID VEREEN JESSOP JR. DOCTOR OF CHIROPRACT
Provider Business Mailing Address
First Line : 2857 S MERIDIAN RD STE 100
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-7960
Country : US
Telephone Number : 208-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 2857 S MERIDIAN RD STE 100
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-7960
Country : US
Telephone Number : 208-888-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2012
Last Update Date : 04/06/2020

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