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General NPI Number Information
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NPI Number | 1164688560
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Entity Type | Organization
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Legal Business Name | JEMD
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 50 MANNING PL
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City | BIRMINGHAM
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State | AL
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Zip | 35242-1809
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Country | US
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Telephone | 205-664-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MANNING PL
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City | BIRMINGHAM
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State | AL
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Zip | 35242-1809
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Country | US
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Telephone | 205-664-7707
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JESSICA DIETRICH-MARSH
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Credential | D.C.
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Telephone | 205-664-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1607
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License Number State | AL
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