Provider Demographics
NPI:1760928626
Name:KEATING, JESSICA L (DC, ND)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:KEATING
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:LODAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, ND
Mailing Address - Street 1:1053 S NORBURY AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3924
Mailing Address - Country:US
Mailing Address - Phone:708-856-6954
Mailing Address - Fax:
Practice Address - Street 1:1053 S NORBURY AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3924
Practice Address - Country:US
Practice Address - Phone:708-856-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
IL038.013067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty