Provider Demographics
NPI:1558110239
Name:STEWART, JESSIE LEIGH (DC)
Entity type:Individual
Prefix:
First Name:JESSIE LEIGH
Middle Name:
Last Name:STEWART
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 S LAMAR RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5373
Mailing Address - Country:US
Mailing Address - Phone:518-321-9521
Mailing Address - Fax:
Practice Address - Street 1:121 W DUNBAR CAVE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6037
Practice Address - Country:US
Practice Address - Phone:931-542-9420
Practice Address - Fax:931-542-9422
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO11247111N00000X
TN3838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor