Provider Demographics
NPI:1427281443
Name:WILL, JESSICA LEA (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEA
Last Name:WILL
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:N1739 LILY OF THE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9105
Mailing Address - Country:US
Mailing Address - Phone:920-268-7352
Mailing Address - Fax:
Practice Address - Street 1:N1739 LILY OF THE VALLEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-9105
Practice Address - Country:US
Practice Address - Phone:920-268-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4526-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor