Provider Demographics
NPI:1871009522
Name:GRADEL, JESSICA R (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:R
Last Name:GRADEL
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-5857
Mailing Address - Country:US
Mailing Address - Phone:419-261-1318
Mailing Address - Fax:
Practice Address - Street 1:152 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-5857
Practice Address - Country:US
Practice Address - Phone:812-590-1584
Practice Address - Fax:509-463-1384
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002964A111N00000X
IN84000197A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist