Provider Demographics
NPI:1235486515
Name:POWELL, JOLENE MELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:MELISSA
Last Name:POWELL
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 1:4810 ELMORE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3423
Mailing Address - Country:US
Mailing Address - Phone:317-250-4656
Mailing Address - Fax:
Practice Address - Street 1:4810 ELMORE AVE STE H
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3423
Practice Address - Country:US
Practice Address - Phone:317-250-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor