Provider Demographics
NPI:1811991441
Name:CARLSTROM, JESSICA B (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:B
Last Name:CARLSTROM
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 1:1520 PARKWAY W
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2381
Mailing Address - Country:US
Mailing Address - Phone:636-937-0100
Mailing Address - Fax:636-937-0103
Practice Address - Street 1:1520 PARKWAY W
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2381
Practice Address - Country:US
Practice Address - Phone:636-937-0100
Practice Address - Fax:636-937-0103
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO163974OtherBLUE CROSS BLUE SHIELD
MO167537OtherGHP
MO516373OtherHEALTHLINK
MO516373OtherHEALTHLINK