Provider Demographics
NPI:1700398138
Name:STAPLES, JESSICA J (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:STAPLES
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 1:17 PELLINORE CT
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1097
Mailing Address - Country:US
Mailing Address - Phone:848-205-6796
Mailing Address - Fax:
Practice Address - Street 1:9630 DEERECO RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2120
Practice Address - Country:US
Practice Address - Phone:410-252-1000
Practice Address - Fax:410-252-6809
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor