Healthcare Provider Details

I. General information

NPI: 1487956306
Provider Name (Legal Business Name): JESSICA L NELSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W ARMITAGE AVE
CHICAGO IL
60647-3862
US

IV. Provider business mailing address

3055 W ARMITAGE AVE
CHICAGO IL
60647-3862
US

V. Phone/Fax

Practice location:
  • Phone: 773-767-3822
  • Fax: 773-767-3944
Mailing address:
  • Phone: 773-767-3822
  • Fax: 773-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: