Provider Demographics
NPI:1255418281
Name:DE JESUS, ROWENA M (DC)
Entity type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:M
Last Name:DE JESUS
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 1:298 ROCK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3211
Mailing Address - Country:US
Mailing Address - Phone:570-708-2228
Mailing Address - Fax:570-708-2039
Practice Address - Street 1:298 ROCK GLEN RD
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3211
Practice Address - Country:US
Practice Address - Phone:570-708-2228
Practice Address - Fax:570-708-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004270L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor