Provider Demographics
NPI:1447738588
Name:WHIDDEN, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHIDDEN
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 1:501 HARBOR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2348
Mailing Address - Country:US
Mailing Address - Phone:850-225-5997
Mailing Address - Fax:
Practice Address - Street 1:501 HARBOR BLVD STE C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2348
Practice Address - Country:US
Practice Address - Phone:850-225-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor