Provider Demographics
NPI:1952441727
Name:SHELLEY, JESSICA U (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:U
Last Name:SHELLEY
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 1:21403 CHAGRIN BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5322
Mailing Address - Country:US
Mailing Address - Phone:216-297-9779
Mailing Address - Fax:
Practice Address - Street 1:14100 CEDAR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3212
Practice Address - Country:US
Practice Address - Phone:216-297-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCU9325381Medicare ID - Type UnspecifiedGROUP
OHSH4085071Medicare ID - Type UnspecifiedINDIVIDUAL