Provider Demographics
NPI:1851467328
Name:JESSEE, MATTHEW BENSON EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BENSON EUGENE
Last Name:JESSEE
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 1:135 PLAZA RD S.W.
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293
Mailing Address - Country:US
Mailing Address - Phone:276-679-2311
Mailing Address - Fax:276-679-2133
Practice Address - Street 1:135 PLAZA RD S.W.
Practice Address - Street 2:SUITE 135
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4613
Practice Address - Country:US
Practice Address - Phone:276-679-2311
Practice Address - Fax:276-679-2133
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA248582OtherANTHEM
VA7970611OtherAETNA
VA7970611OtherAETNA
VAV04779Medicare UPIN