Provider Demographics
NPI:1841732112
Name:COGO, JESSICA ALYSSE SANTOS (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALYSSE SANTOS
Last Name:COGO
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 1:22A PLATEAU LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7439
Mailing Address - Country:US
Mailing Address - Phone:386-986-8013
Mailing Address - Fax:
Practice Address - Street 1:9 PALM HARBOR VILLAGE WAY STE D
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:138-660-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 12011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor