Provider Demographics
NPI:1346378841
Name:PETERS, JESSICA ROSE (DC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ROSE
Last Name:PETERS
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 1:204 QUINCE ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4009
Mailing Address - Country:US
Mailing Address - Phone:360-705-1121
Mailing Address - Fax:360-705-6523
Practice Address - Street 1:204 QUINCE ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4009
Practice Address - Country:US
Practice Address - Phone:360-705-1121
Practice Address - Fax:360-705-6523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor