Provider Demographics
NPI:1770980120
Name:STALLMAN, JESSICA JEANNINE
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JEANNINE
Last Name:STALLMAN
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:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-1649
Mailing Address - Country:US
Mailing Address - Phone:231-938-3830
Mailing Address - Fax:231-938-3831
Practice Address - Street 1:3875 M-72 E
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-4969
Practice Address - Country:US
Practice Address - Phone:231-938-3830
Practice Address - Fax:231-938-3831
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor