Provider Demographics
NPI:1679704357
Name:DAVIDSON, JESSICA MICHELLE (DC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:DAVIDSON
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 1:901 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1101
Mailing Address - Country:US
Mailing Address - Phone:270-922-1785
Mailing Address - Fax:610-461-0142
Practice Address - Street 1:901 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1101
Practice Address - Country:US
Practice Address - Phone:270-922-1785
Practice Address - Fax:610-461-0142
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor