Provider Demographics
NPI:1710075197
Name:MULLEN, JESSIE STEVENS (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:STEVENS
Last Name:MULLEN
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 1:1814 N ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-6303
Mailing Address - Country:US
Mailing Address - Phone:704-735-9668
Mailing Address - Fax:704-735-9775
Practice Address - Street 1:1814 N ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-6303
Practice Address - Country:US
Practice Address - Phone:704-735-9668
Practice Address - Fax:704-735-9775
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085KMMedicaid
NC89085KMMedicaid