Provider Demographics
NPI:1891832341
Name:LOVE, JODY K (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:K
Last Name:LOVE
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0127
Mailing Address - Country:US
Mailing Address - Phone:509-997-7062
Mailing Address - Fax:509-997-7022
Practice Address - Street 1:614 CANYON ROAD
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-7062
Practice Address - Fax:509-997-7022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001979111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician