Provider Demographics
NPI:1275691974
Name:JENNINGS, JESSICA PELAR (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PELAR
Last Name:JENNINGS
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 1:644 STATESVILLE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2281
Mailing Address - Country:US
Mailing Address - Phone:704-798-9802
Mailing Address - Fax:704-310-5715
Practice Address - Street 1:644 STATESVILLE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-798-9802
Practice Address - Fax:704-310-5715
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU99839Medicare UPIN