Provider Demographics
NPI:1629780630
Name:CARNEY, JESSICA NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NICOLE
Last Name:CARNEY
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:PO BOX 360234
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0234
Mailing Address - Country:US
Mailing Address - Phone:321-255-3003
Mailing Address - Fax:321-255-3005
Practice Address - Street 1:1565 SARNO RD STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5268
Practice Address - Country:US
Practice Address - Phone:321-255-3003
Practice Address - Fax:321-255-3005
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor