Provider Demographics
NPI:1861447716
Name:RICCHIO, JESSICA SHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SHEA
Last Name:RICCHIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6318
Mailing Address - Country:US
Mailing Address - Phone:307-674-6655
Mailing Address - Fax:307-674-6699
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6318
Practice Address - Country:US
Practice Address - Phone:307-674-6655
Practice Address - Fax:307-674-6699
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor