Provider Demographics
NPI:1508343039
Name:JESSICA ANN LLC
Entity Type:Organization
Organization Name:JESSICA ANN LLC
Other - Org Name:JOURNEY TO HEALTH CHIROPRACTIC AND ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-459-5713
Mailing Address - Street 1:5561 S PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2746
Mailing Address - Country:US
Mailing Address - Phone:573-528-6260
Mailing Address - Fax:
Practice Address - Street 1:1440 W REPUBLIC RD STE 112
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5754
Practice Address - Country:US
Practice Address - Phone:417-459-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001597788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty