Provider Demographics
NPI:1245744457
Name:OSTRANDER, JESSICA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:OSTRANDER
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 1:1023 FOX TRACE CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4978
Mailing Address - Country:US
Mailing Address - Phone:307-575-9065
Mailing Address - Fax:
Practice Address - Street 1:717 MCDOWELL AVENUE
Practice Address - Street 2:
Practice Address - City:LINGLE
Practice Address - State:WY
Practice Address - Zip Code:82223
Practice Address - Country:US
Practice Address - Phone:307-575-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor