Healthcare Provider Details

I. General information

NPI: 1477361202
Provider Name (Legal Business Name): JESSICA WEHRLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 10TH AVE E
MILAN IL
61264-2953
US

IV. Provider business mailing address

326 6TH ST W
ANDALUSIA IL
61232-9411
US

V. Phone/Fax

Practice location:
  • Phone: 309-787-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.014232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: