Provider Demographics
NPI:1679858369
Name:NEILEN, JESS ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:ALAN
Last Name:NEILEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 N DIXIE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3916
Mailing Address - Country:US
Mailing Address - Phone:954-332-9999
Mailing Address - Fax:954-281-5402
Practice Address - Street 1:4711 N DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3916
Practice Address - Country:US
Practice Address - Phone:954-332-9999
Practice Address - Fax:954-281-5402
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor