Provider Demographics
NPI:1023221652
Name:CHRISTOPHERSON, JESSICA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 S COLLEGE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3700
Mailing Address - Country:US
Mailing Address - Phone:970-226-6002
Mailing Address - Fax:
Practice Address - Street 1:4730 S COLLEGE AVE
Practice Address - Street 2:STE 103
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3700
Practice Address - Country:US
Practice Address - Phone:970-226-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor