Healthcare Provider Details

I. General information

NPI: 1679258164
Provider Name (Legal Business Name): JESSICA HUCK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 EMERSON AVE
PARKERSBURG WV
26104-1217
US

IV. Provider business mailing address

545 MASONIC PARK LN
MARIETTA OH
45750-5369
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-8300
  • Fax:
Mailing address:
  • Phone: 614-530-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1085
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: