Provider Demographics
NPI:1831693555
Name:JESSO, KIMBERLEY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:JESSO
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 1:4504 W SPRUCE ST APT 208
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5793
Mailing Address - Country:US
Mailing Address - Phone:386-562-8447
Mailing Address - Fax:
Practice Address - Street 1:4504 W SPRUCE ST APT 208
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5793
Practice Address - Country:US
Practice Address - Phone:386-562-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor