Healthcare Provider Details

I. General information

NPI: 1003744699
Provider Name (Legal Business Name): JESSICA L BISHOP LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MAPLE ST
VALPARAISO IN
46383-4723
US

IV. Provider business mailing address

111 N WABASH AVE STE 100
CHICAGO IL
60602-1903
US

V. Phone/Fax

Practice location:
  • Phone: 260-343-1755
  • Fax:
Mailing address:
  • Phone: 312-463-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000245A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: