Provider Demographics
NPI:1437928512
Name:PHIBBS, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PHIBBS
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 1:140 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1831
Mailing Address - Country:US
Mailing Address - Phone:618-327-2000
Mailing Address - Fax:618-327-8770
Practice Address - Street 1:140 S MILL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1831
Practice Address - Country:US
Practice Address - Phone:618-327-2000
Practice Address - Fax:618-327-8770
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor