Provider Demographics
NPI:1114116761
Name:JESSICA L TOBIN
Entity Type:Organization
Organization Name:JESSICA L TOBIN
Other - Org Name:TOBIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-754-3436
Mailing Address - Street 1:403 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1927
Mailing Address - Country:US
Mailing Address - Phone:307-754-3436
Mailing Address - Fax:307-754-7938
Practice Address - Street 1:403 E 2ND ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1927
Practice Address - Country:US
Practice Address - Phone:307-754-3436
Practice Address - Fax:307-754-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2016-02-19
Deactivation Date:2008-01-22
Deactivation Code:
Reactivation Date:2008-05-13
Provider Licenses
StateLicense IDTaxonomies
WY657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20739Medicare PIN
WYV08822Medicare UPIN