Provider Demographics
NPI:1578885307
Name:CORTESE, JAMIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:CORTESE
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 1:1810 WEBSTER ST 5
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9324
Mailing Address - Country:US
Mailing Address - Phone:175-808-0445
Mailing Address - Fax:
Practice Address - Street 1:1810 WEBSTER ST 5
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9324
Practice Address - Country:US
Practice Address - Phone:715-808-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4589-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor