Provider Demographics
NPI:1164825139
Name:SPEIDEL, JESSICA ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELLEN
Last Name:SPEIDEL
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 1:1605 WAKARUSA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1805
Mailing Address - Country:US
Mailing Address - Phone:785-842-4181
Mailing Address - Fax:785-842-6436
Practice Address - Street 1:1605 WAKARUSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1805
Practice Address - Country:US
Practice Address - Phone:785-842-4181
Practice Address - Fax:785-842-6436
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor