Provider Demographics
NPI:1942719927
Name:TEW, JESSICA VILLA (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VILLA
Last Name:TEW
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8386
Mailing Address - Country:US
Mailing Address - Phone:770-864-1195
Mailing Address - Fax:770-864-1169
Practice Address - Street 1:480 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8386
Practice Address - Country:US
Practice Address - Phone:770-864-1195
Practice Address - Fax:770-864-1169
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor