Provider Demographics
NPI:1184376915
Name:LODES, JESSICA (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:LODES
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 1:519 PAPER MILL RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2008
Mailing Address - Country:US
Mailing Address - Phone:215-885-9070
Mailing Address - Fax:
Practice Address - Street 1:519 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-2008
Practice Address - Country:US
Practice Address - Phone:215-885-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor