Provider Demographics
NPI:1669113445
Name:PORTER, JESSCIA (DC)
Entity type:Individual
Prefix:DR
First Name:JESSCIA
Middle Name:
Last Name:PORTER
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 1:1932 GRASSLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2976
Mailing Address - Country:US
Mailing Address - Phone:913-980-6010
Mailing Address - Fax:
Practice Address - Street 1:1932 GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2976
Practice Address - Country:US
Practice Address - Phone:913-980-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty