Provider Demographics
NPI:1851725394
Name:TALLMAN, JESSICA MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MAE
Last Name:TALLMAN
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 1:417 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4311
Mailing Address - Country:US
Mailing Address - Phone:417-294-2663
Mailing Address - Fax:
Practice Address - Street 1:11960 QUIVIRA RD STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2579
Practice Address - Country:US
Practice Address - Phone:913-402-7444
Practice Address - Fax:913-402-7450
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-01
Last Update Date:2013-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor