Provider Demographics
NPI:1942368188
Name:TOBIN, JESSICA L (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:TOBIN
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 1:403 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1927
Mailing Address - Country:US
Mailing Address - Phone:307-754-3436
Mailing Address - Fax:
Practice Address - Street 1:403 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1929
Practice Address - Country:US
Practice Address - Phone:307-754-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20739Medicare PIN
WYV08822Medicare UPIN