Provider Demographics
NPI:1053676023
Name:TROMBLA, JESSE DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DANIEL
Last Name:TROMBLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7419 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1975
Mailing Address - Country:US
Mailing Address - Phone:913-579-1154
Mailing Address - Fax:913-273-0081
Practice Address - Street 1:7419 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1975
Practice Address - Country:US
Practice Address - Phone:913-579-1154
Practice Address - Fax:913-273-0081
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor