Provider Demographics
NPI:1598836140
Name:LODA, JESSICA E (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:E
Last Name:LODA
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 1:726 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3215
Mailing Address - Country:US
Mailing Address - Phone:607-256-0641
Mailing Address - Fax:
Practice Address - Street 1:726 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3215
Practice Address - Country:US
Practice Address - Phone:607-256-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010724-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD7079Medicare ID - Type Unspecified
NYU96894Medicare UPIN