Provider Demographics
NPI:1285814236
Name:NESSELER, JERRY EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:EDWARD
Last Name:NESSELER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HIGHWAY 150
Mailing Address - Street 2:SUITE 129H
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4007
Mailing Address - Country:US
Mailing Address - Phone:205-444-0727
Mailing Address - Fax:205-444-9499
Practice Address - Street 1:2801 HIGHWAY 150 STE 129H
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4021
Practice Address - Country:US
Practice Address - Phone:205-444-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU56332Medicare UPIN