Provider Demographics
NPI:1790198570
Name:EVERSON, JESSICA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:EVERSON
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 1:425 S AVALON PARK BLVD
Mailing Address - Street 2:STE. 1000
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6998
Mailing Address - Country:US
Mailing Address - Phone:407-930-3696
Mailing Address - Fax:407-930-3697
Practice Address - Street 1:425 S AVALON PARK BLVD
Practice Address - Street 2:STE. 1000
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6998
Practice Address - Country:US
Practice Address - Phone:407-930-3696
Practice Address - Fax:407-930-3697
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor