Provider Demographics
NPI:1720315617
Name:DZIURKOWSKI, JESSICA JOY (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JOY
Last Name:DZIURKOWSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:JOY
Other - Last Name:FESTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:84 FERNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5993
Mailing Address - Country:US
Mailing Address - Phone:501-707-8208
Mailing Address - Fax:
Practice Address - Street 1:84 FERNCREST DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5993
Practice Address - Country:US
Practice Address - Phone:501-707-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AO08GA86Medicare PIN