Provider Demographics
NPI:1457936700
Name:KADER, JESSE
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:KADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 FOREST BRANCH DR APT C
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-8948
Mailing Address - Country:US
Mailing Address - Phone:321-236-6326
Mailing Address - Fax:
Practice Address - Street 1:16349 PHIL RITSON WAY STE 7
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6200
Practice Address - Country:US
Practice Address - Phone:321-236-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty