Provider Demographics
NPI:1306914924
Name:FOY, JESSE (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:FOY
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 N 115TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3446
Mailing Address - Country:US
Mailing Address - Phone:414-254-0223
Mailing Address - Fax:
Practice Address - Street 1:4040 N CALHOUN RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1336
Practice Address - Country:US
Practice Address - Phone:262-901-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI435055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11634122OtherCAQH PROVIDER NUMBER