=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003491218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GISSY FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2021
-----------------------------------------------------
Last Update Date | 03/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5026 SEMINOLE PRATT WHITNEY RD
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-6301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-309-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 GREENMONT HILLS DR
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26105-3280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-309-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. JESSICA A GISSY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 561-309-9922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------