Provider Demographics
NPI:1386471258
Name:JENNESTREET, CIERRA (DC)
Entity type:Individual
Prefix:DR
First Name:CIERRA
Middle Name:
Last Name:JENNESTREET
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 1:219 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5649
Mailing Address - Country:US
Mailing Address - Phone:757-259-1122
Mailing Address - Fax:
Practice Address - Street 1:219 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5649
Practice Address - Country:US
Practice Address - Phone:757-259-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15180111N00000X
VA0104558040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor