Provider Demographics
NPI:1750068326
Name:PRATTS SANTIAGO, JESSENIA LIZ
Entity type:Individual
Prefix:
First Name:JESSENIA
Middle Name:LIZ
Last Name:PRATTS SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HALTON RD APT 7002
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3484
Mailing Address - Country:US
Mailing Address - Phone:787-432-0591
Mailing Address - Fax:
Practice Address - Street 1:403 PARKER IVEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6513
Practice Address - Country:US
Practice Address - Phone:864-288-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor