Provider Demographics
NPI:1922041672
Name:MEADE, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MEADE
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 1:610 TEN ROD ROAD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-295-9767
Mailing Address - Fax:401-295-0230
Practice Address - Street 1:610 TEN ROD ROAD
Practice Address - Street 2:UNIT 4
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-295-9767
Practice Address - Fax:401-295-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98819Medicare UPIN
RI709003399Medicare ID - Type UnspecifiedGROUP