Provider Demographics
NPI:1427747385
Name:SHOEMAKER, JESSICA LYNNE (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:SHOEMAKER
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 1:4453 S ATLANTIC AVE UNIT 208
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7166
Mailing Address - Country:US
Mailing Address - Phone:810-335-0085
Mailing Address - Fax:
Practice Address - Street 1:3013 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3701
Practice Address - Country:US
Practice Address - Phone:407-960-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor