Healthcare Provider Details

I. General information

NPI: 1861447716
Provider Name (Legal Business Name): JESSICA SHEA RICCHIO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N MAIN ST SUITE 201
SHERIDAN WY
82801-6318
US

IV. Provider business mailing address

2 N MAIN ST SUITE 201
SHERIDAN WY
82801-6318
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-6655
  • Fax: 307-674-6699
Mailing address:
  • Phone: 307-674-6655
  • Fax: 307-674-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number684
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: