Provider Demographics
NPI:1770764425
Name:KATZ, JESSICA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:KATZ
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 1:566 BEDFORD KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-2023
Mailing Address - Country:US
Mailing Address - Phone:336-996-7007
Mailing Address - Fax:336-996-7005
Practice Address - Street 1:1407 NC HIGHWAY 66 S
Practice Address - Street 2:SUITE G
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3791
Practice Address - Country:US
Practice Address - Phone:336-996-7007
Practice Address - Fax:336-996-7005
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911846Medicaid
NC12124636OtherCAQH
NC5911846Medicaid