Provider Demographics
NPI:1407881279
Name:JESSUP, JENNIFER L (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:JESSUP
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 1:223 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3408
Mailing Address - Country:US
Mailing Address - Phone:937-335-1551
Mailing Address - Fax:937-335-1288
Practice Address - Street 1:50 TROY TOWN DR
Practice Address - Street 2:SUITE B
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2341
Practice Address - Country:US
Practice Address - Phone:937-335-1551
Practice Address - Fax:937-335-1288
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor