Provider Demographics
NPI:1346247319
Name:DEAN, JESSE A III (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:A
Last Name:DEAN
Suffix:III
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 1:1086 W VAN HOOK ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3026
Mailing Address - Country:US
Mailing Address - Phone:731-686-3343
Mailing Address - Fax:731-686-7353
Practice Address - Street 1:1086 W VAN HOOK ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3026
Practice Address - Country:US
Practice Address - Phone:731-686-3343
Practice Address - Fax:731-686-7353
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971607Medicare ID - Type Unspecified
TNU85348Medicare UPIN