Provider Demographics
NPI:1427057249
Name:HELLER, JESSICA LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:HELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:GOESSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8812 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2726
Mailing Address - Country:US
Mailing Address - Phone:414-774-2300
Mailing Address - Fax:414-774-0341
Practice Address - Street 1:8812 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2726
Practice Address - Country:US
Practice Address - Phone:414-774-2300
Practice Address - Fax:414-774-0341
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3892012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94025Medicare UPIN