Provider Demographics
NPI:1346746625
Name:LOVELESS, JESSICA L (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LOVELESS
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 1:16004 W 149TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2651
Mailing Address - Country:US
Mailing Address - Phone:913-549-2246
Mailing Address - Fax:
Practice Address - Street 1:8016 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3721
Practice Address - Country:US
Practice Address - Phone:913-732-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05880111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS01-05880OtherKANSAS STATE BOARD OF HEALING ARTS